Skip to main content
SpringerLink
Log in

Predisposing factors for postoperative nausea and vomiting in gynecologic tumor patients

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the predictors of postoperative nausea and vomiting (PONV) in women with gynecologic tumor.

Methods

The analysis was based on prospectively collected data of 82 adult patients with gynecologic tumor, who were submitted to open surgical treatment and undergoing general anesthesia. The predictors included were age ≥50 years, non-smoker, use of postoperative opioids, mechanical bowel preparation, intraoperative intravenous hydration (IH) ≥10 mL/kg/h, and IH in the immediate postoperative, first and second postoperative days (PO1 and PO2) ≥30 mL/kg. A score with predictor variables was built. A multiple logistic regression was fitted. To estimate the discriminating power of the chosen model, a receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was calculated. Statistical significance was set at p value <0.05 and the confidence interval at 95 %.

Results

The incidence (%) of nausea, vomiting and both, in the general population, was 36.6, 28.1, 22.0, respectively. The highest incidences of PONV were found in non-smokers and in patients who received >30 mL/kg of IH in the PO2. The results of the adjusted model showed an increased risk of PONV for each 1-point increase in the score punctuation. The relative risk was higher than 2.0 for vomiting in all period and in the PO1. The ROC curve showed great discrimination of postoperative nausea and vomiting from the proposed score (AUC >0.75).

Conclusions

The study population was at high risk of PONV. Therefore, institutional guidelines abolishing modificable variables following temporal evaluation of the effectiveness should be undertaken.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Peixoto AJ, Peixoto Filho AJ, Leães LF, Celich MF, Barros MAV (2000) Efficacy of prophylactic droperidol, ondansetron or both in the prevention of post operative nausea and vomiting in major gynaecological surgery. A prospective, randomized, double-blind clinical trial. Eur J Anaesthesiol 17:611–615

    Article  CAS  PubMed  Google Scholar 

  2. Gupta A, Wu CL, Elkassabany N, Krug CE, Parker SD, Fleisher LA (2003) Does the routine prophylactic use of antiemetics affect the incidence of post discharge nausea and vomiting following ambulatory surgery? A systematic review of randomized controlled trials. Anesthesiology 99(2):488–495

    Article  PubMed  Google Scholar 

  3. Habib AS, El-Moalem HE, Gan TJ (2004) The efficacy of the 5-HT3 receptor antagonists combined with droperidol for PONV prophylaxis is similar to their combination with dexamethasone. A meta-analysis of randomized controlled trials. Can J Anaesth 51(4):311–319

    Article  PubMed  Google Scholar 

  4. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N (1999) A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 91:693–700

    Article  CAS  PubMed  Google Scholar 

  5. Woodhouse A, Mather LE (1998) The effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy. Br J Clin Pharmacol 45:57–62

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Cohen MM, Ducan PG, DeBoer DP, Tweed WA (1994) The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 78(1):7–16

    Article  CAS  PubMed  Google Scholar 

  7. Kenny GN (1994) Risk factors for postoperative nausea and vomiting. Anaesthesia 49:6–10

    Article  PubMed  Google Scholar 

  8. Sinclair DR, Chung F, Mezei G (1999) Can postoperative nausea and vomiting be predicted? Anesthesiology 91(1):109–118

    Article  CAS  PubMed  Google Scholar 

  9. Apfel CC, Greim CA, Haubitz I, et al. (1998) The discriminating power of a risk score for postoperative vomiting in adults undergoing various types of surgery. Acta Anaesthesiol Scand 42(5):502–509

    Article  CAS  PubMed  Google Scholar 

  10. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. (2005) Enhanced recovery after surgery: a consensus review of clinical care of patients undergoing colonic resection. Clin Nutr 24:466–477

    Article  CAS  PubMed  Google Scholar 

  11. Wu YH, Sun HS, Wang ST, Tseng CA (2015) Applicability of risk scores for postoperative nausea and vomiting in a Taiwanese population undergoing general anaesthesia. Anaesth Intensive Care 43(4):473–478

    CAS  PubMed  Google Scholar 

  12. Gadducci A, Cosio S, Spirito N, Genazzani AR (2010) The perioperative management of patients with gynaecological cancer undergoing major surgery: a debated clinical challenge. Crit Rev Oncol Hematol 73(2):126–140

    Article  PubMed  Google Scholar 

  13. Mutch DG (2009) The new FIGO staging system for cancers of the vulva, cervix, endometrium, and sarcomas. Gynecol Oncol 115:325–328

    Article  Google Scholar 

  14. World Health Organization (1995) Physical status: the use and interpretation of anthropometry. WHO, Geneva

    Google Scholar 

  15. World Health Organization (2004) Obesity: preventing and managing the global epidemic. WHO, Geneva

    Google Scholar 

  16. Organización Panamericana de la Salud (2001) XXXVI Reunión del Comité Asesor de Investigaciones en Salud. Encuesta Multicéntrica Salud, Bienestar y envejecimiento (SABE) en América Latina y el Caribe - Informe Preliminar. División de promoción y protección de la salud (HPP). Washington, D.C.: Organización Panamericana de la Salud (OPAS)

  17. MacKay G, Fearon K, McConnachie A, Serpell MG, Molloy RG, O’Dwyer PJ (2006) Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery. Br J Surg 93:1469–1474

    Article  CAS  PubMed  Google Scholar 

  18. Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C, Silva RM, Cardoso EA, Santos TP (2008) Enhancing surgical recovery in central-west Brasil: the ACERTO protocol results. e-SPEN 3:e78–e83

    Article  Google Scholar 

  19. Chongsuvivatwong V (2012). epicalc: Epidemiological calculator. R package version 2.15.1.0. Available online: http://CRAN.R-project.org/package=epicalc

  20. Robin X, Turck N, Hainard A, et al. (2011) pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics 12:77

    Article  PubMed  PubMed Central  Google Scholar 

  21. R Development Core Team (2014). R: A language and environment for statistical computing. The R Foundation for Statistical Computing. Available online: http://www.R-project.org/

  22. Macario A, Weinger M, Carney S, Kim A (1999) Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 89(3):652–658

    CAS  PubMed  Google Scholar 

  23. Parra-Sanchez I, Abdallah R, You J, et al. (2012) A time-motion economic analysis of postoperative nausea and vomiting in ambulatory surgery. Can J Anaesth 59(4):366–375

    Article  PubMed  Google Scholar 

  24. McKenzie R, Kovac A, O’Connor T, et al. (1993) Comparison of ondansetron versus placebo to prevent postoperative nausea and vomiting in women undergoing ambulatory gynecologic surgery. Anesthesiology 78:21–28

    Article  CAS  PubMed  Google Scholar 

  25. Camu F, Lauwers MH, Verbessem D (1992) Incidence and aetiology of postoperative nausea and vomiting. Eur J Anaesthesiol 9:25–31

    Google Scholar 

  26. Macafee DA, Allison SP, Lobo DN (2005) Some interaction between gastrointestinal function and fluid and eletrolyte homeostasis. Curr Opin Clin Nutr Metab Care 8:197–203

    Article  PubMed  Google Scholar 

  27. Hausel J, Nygren J, Thorell A, Lagerkranser M, Ljunggvist O (2005) Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. Br J Surg 92(4):415–421

    Article  CAS  PubMed  Google Scholar 

  28. Gründel K, Schwenk W, Böhm B, Muller JM (1997) Improvements in mechanical bowel preparation for elective colorectal surgery. Dis Colon rectum 40:1348–1352

    Article  PubMed  Google Scholar 

  29. Jung B, Lannerstad O, Pahlman L, Arodell M, Unosson M, Nilsson E (2007) Preoperative mechanical preparation of the colon: the patient’s experience. BMC Surg 7:5

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wells T, Plante M, McAlpine JN (2011) Communities of practice groups on behalf of the Society of Gynecologic Oncologists of Canada. Preoperative bowel preparation in gynecologic oncology: a review of practice patterns and an impetus to change. Int J Gynecol Cancer 21(6):1135–1142

    Article  PubMed  Google Scholar 

  31. Nygren J, Thacker J, Carli F, et al. (2013) Guidelines for perioperative care in elective rectal/pelvic surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg 37:285–305

    Article  CAS  PubMed  Google Scholar 

  32. Jorgensen H, Wetterslev J, Moiniche S, Dahl JB (2000). Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev CD001893.

  33. Fisher DM (1997) The “big little problem” of postoperative nausea and vomiting: do we know the answer yet? Anesthesiology 87:1271–1273

    Article  CAS  PubMed  Google Scholar 

  34. Gan TJ, Diemunsch P, Habib AS, et al. (2014) Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 118(1):85–113

    Article  PubMed  Google Scholar 

  35. Myklejord DJ, Yao L, Liang H, Glurich I (2012) Consensus guideline adoption for managing postoperative nausea and vomiting. WMJ 111(5):207–213

    PubMed  Google Scholar 

  36. Biedler A, Wermelt J, Kunitz O, et al. (2004) A risk adapted approach reduces the overall institutional incidence of postoperative nausea and vomiting. Can J Anesth 51(1):13–19

    Article  PubMed  Google Scholar 

  37. Pierre S, Corno G, Beanias H, Apfel CC (2004) A risk score-dependent antiemetic approach effectively reduces postoperative nausea and vomiting—a continuous quality improvement initiative. Can J Anesth 51(4):320–325

    Article  PubMed  Google Scholar 

  38. Kranke P (2011) Effective management of postoperative nausea and vomiting: let us practise what we preach! Eur J Anaesthesiol 28(3):152–154

    Article  PubMed  Google Scholar 

  39. Pierre S (2000) Risk scores for predicting postoperative nausea and vomiting are clinically useful tools and should be used in every patient: pro—‘don’t throw the baby out with the bathwater. Eur J Anaesthesiol 28(3):160–163

    Article  Google Scholar 

  40. Eberhart LH, Morin AM (2011) Risk scores for predicting postoperative nausea and vomiting are clinically useful tools and should be used in every patient: con—‘life is really simple, but we insist on making it complicated. Eur J Anaesthesiol 28(3):155–159

    Article  PubMed  Google Scholar 

  41. Kranke P, Eberhart LH, Gan TJ, Roewer N, Tramer MR (2007) Algorithms for the prevention of postoperative nausea and vomiting: an efficacy and efficiency stimulation. Eur J Anaesthesiol 24(10):856–867

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nutrition and Dietetics, State University of Rio de Janeiro, Rio de Janeiro, Brazil

    Daiane Spitz de Souza

  2. Department of Nutrition and Dietetics, Brazilian National Cancer Institute, Rio de Janeiro, Brazil

    Amine Farias Costa & Gabriela Villaça Chaves

  3. National Cancer Institute, Rua Equador 831, Rio de Janeiro, RJ, 20220-410, Brazil

    Gabriela Villaça Chaves

Authors
  1. Daiane Spitz de Souza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amine Farias Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriela Villaça Chaves
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabriela Villaça Chaves.

Ethics declarations

The study protocol was approved by the Brazilian Cancer Institute (INCA – Instituto Nacional de Câncer José Alencar Gomes da Silva) ethics committee (CAAE number 01,052,712.9.0000.5274). Patients were admitted into the study upon providing written formal authorization through a free and informed consent agreement.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Souza, D.S., Costa, A.F. & Chaves, G.V. Predisposing factors for postoperative nausea and vomiting in gynecologic tumor patients. Support Care Cancer 24, 4661–4667 (2016). https://doi.org/10.1007/s00520-016-3311-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-016-3311-2

Keywords

Search

Navigation