Retrospective Review of PONV Practice Patterns at a Large Academic Medical Center
1. Retrospective Review of PONV Practice Patterns at a Large Academic Medical Center
Purpose
Stephen Rivoli DO MPH, Alexis Rondon, Luis Ignacio Rodriguez MD
Department of Anesthesiology, University of Miami/Jackson Heath System Miami, FL
In 2015, our group in the Department of
Anesthesiology, Perioperative Medicine and Pain
Management at the University of Miami began a
retrospective review of our operative procedures at
Jackson Memorial Hospital in the context of the
non-PQRS measures concerning postoperative
nausea and vomiting (PONV) [1]. The goal of this
research is to better understand our current practice
prior to targeted intervention to improve measure
compliance and provide better care for our patients.
One of the most common and most distracting
effects of procedural anesthesia is PONV[2]. PONV
can cause discomfort and pain which lead to poor
patient experiences and, in some cases, may result
in serious consequences from vomiting such as
aspiration of gastric content or esophageal rupture
[6]. As many as 20-30% of patients experience
PONV if no prophylaxis is administered [5]. This
number can increase to 80% in patients with multiple
risk factors including history of PONV, smoking,
female gender, and opioid use [3].
Background
Methodology
For our review, we analyzed perioperative data from
our PICIS electronic anesthesia record system. The
data set ranged from January 1, 2010 to December
31, 2015 and originally included 68,276 procedures
performed at Jackson Memorial Hospital; of those, 38
cases (0.05%) were removed due to missing data
elements.
From our data set, we focused on the adult population
(age>17 years). The variables we examined included type
of anesthesia received, PONV risk factors, and
pharmacologic prophylaxis administered. Of the 59,066
adult cases, 47,921 (81%) received some form of general
anesthetic. Within this group, 46,650 received some type
of inhalational agent as part of the general anesthesia
technique.
When first examined the risk factors of that adult subset
who received an inhalational agent as part of general
anesthesia [Table #1]. We also examined the three
pharmacologic agents most often used in our practice
within that same population [Table #2].
49.4% our population over the past 5 years has received
at least 1 prophylactic agent (23,042 cases), 8.8% (4,125
cases) of which received multimodal treatment. When
considering risk factors, however, only 3.4% of patients
(1,616 cases) were identified as positive for at least 3 risk
factors. Of these, the average multimodal PONV
prophylaxis usage was 14.98% (242 cases).
Results
Conclusion/Comment
• Regarding the non-smoker risk factor in
particular, we found very few patients to be “true”
non-smokers, however, we followed the least
restrictive exclusion criteria by including former
and social smokers.
• Regarding the prophylactic agent usage, our data
shows opportunity to improve the usage of
multimodal prophylaxis in the high risk patients
likely by building on our solid usage of
ondansetron with another agent.
• Our data does show increasing usage of
multimodal prophylaxis over time.
1. http://www.aqihq.org/files/pqrs/2015_AQI_non-PQRS_Measures_Narrative__Final.pdf
2. Franck M., Radtke F.M., Apfel C.C., et al: Documentation of postoperative nausea and
vomiting in routine clinical practice. J Int Med Res 2010; 38: pp. 1034-1041
3. Apfel C.C., Laara E., Koivuranta M., et al: A simplified risk score for predicting postoperative
nausea and vomiting: conclusions from cross-validations between two centers.
Anesthesiology 1999; 91: pp. 693-700
4. Blacoe D.A., Cunning E., and Bell G.: Paediatric day-case surgery: an audit of unplanned
hospital admission Royal Hospital for Sick Children, Glasgow. Anaesthesia 2008; 63: pp.
610-615
5. Voigt M, Frohlich C, Waschke K, et al: Prophylaxis of postoperative nausea and vomiting in
elective breast surgery. Journal of Clinical Anesthesia 2011; 23: pp. 461-468
6. Wu Y, Sun H, Wang S, et al: Applicability of risk scores for postoperative nausea and
vomiting in a Taiwanese population undergoing general anesthesia. Anaesthesia Intensive
Care 2015; 43: pp 473-478
References
![Retrospective Review of PONV Practice Patterns at a Large Academic Medical Center
Purpose
Stephen Rivoli DO MPH, Alexis Rondon, Luis Ignacio Rodriguez MD
Department of Anesthesiology, University of Miami/Jackson Heath System Miami, FL
In 2015, our group in the Department of
Anesthesiology, Perioperative Medicine and Pain
Management at the University of Miami began a
retrospective review of our operative procedures at
Jackson Memorial Hospital in the context of the
non-PQRS measures concerning postoperative
nausea and vomiting (PONV) [1]. The goal of this
research is to better understand our current practice
prior to targeted intervention to improve measure
compliance and provide better care for our patients.
One of the most common and most distracting
effects of procedural anesthesia is PONV[2]. PONV
can cause discomfort and pain which lead to poor
patient experiences and, in some cases, may result
in serious consequences from vomiting such as
aspiration of gastric content or esophageal rupture
[6]. As many as 20-30% of patients experience
PONV if no prophylaxis is administered [5]. This
number can increase to 80% in patients with multiple
risk factors including history of PONV, smoking,
female gender, and opioid use [3].
Background
Methodology
For our review, we analyzed perioperative data from
our PICIS electronic anesthesia record system. The
data set ranged from January 1, 2010 to December
31, 2015 and originally included 68,276 procedures
performed at Jackson Memorial Hospital; of those, 38
cases (0.05%) were removed due to missing data
elements.
From our data set, we focused on the adult population
(age>17 years). The variables we examined included type
of anesthesia received, PONV risk factors, and
pharmacologic prophylaxis administered. Of the 59,066
adult cases, 47,921 (81%) received some form of general
anesthetic. Within this group, 46,650 received some type
of inhalational agent as part of the general anesthesia
technique.
When first examined the risk factors of that adult subset
who received an inhalational agent as part of general
anesthesia [Table #1]. We also examined the three
pharmacologic agents most often used in our practice
within that same population [Table #2].
49.4% our population over the past 5 years has received
at least 1 prophylactic agent (23,042 cases), 8.8% (4,125
cases) of which received multimodal treatment. When
considering risk factors, however, only 3.4% of patients
(1,616 cases) were identified as positive for at least 3 risk
factors. Of these, the average multimodal PONV
prophylaxis usage was 14.98% (242 cases).
Results
Conclusion/Comment
• Regarding the non-smoker risk factor in
particular, we found very few patients to be “true”
non-smokers, however, we followed the least
restrictive exclusion criteria by including former
and social smokers.
• Regarding the prophylactic agent usage, our data
shows opportunity to improve the usage of
multimodal prophylaxis in the high risk patients
likely by building on our solid usage of
ondansetron with another agent.
• Our data does show increasing usage of
multimodal prophylaxis over time.
1. http://www.aqihq.org/files/pqrs/2015_AQI_non-PQRS_Measures_Narrative__Final.pdf
2. Franck M., Radtke F.M., Apfel C.C., et al: Documentation of postoperative nausea and
vomiting in routine clinical practice. J Int Med Res 2010; 38: pp. 1034-1041
3. Apfel C.C., Laara E., Koivuranta M., et al: A simplified risk score for predicting postoperative
nausea and vomiting: conclusions from cross-validations between two centers.
Anesthesiology 1999; 91: pp. 693-700
4. Blacoe D.A., Cunning E., and Bell G.: Paediatric day-case surgery: an audit of unplanned
hospital admission Royal Hospital for Sick Children, Glasgow. Anaesthesia 2008; 63: pp.
610-615
5. Voigt M, Frohlich C, Waschke K, et al: Prophylaxis of postoperative nausea and vomiting in
elective breast surgery. Journal of Clinical Anesthesia 2011; 23: pp. 461-468
6. Wu Y, Sun H, Wang S, et al: Applicability of risk scores for postoperative nausea and
vomiting in a Taiwanese population undergoing general anesthesia. Anaesthesia Intensive
Care 2015; 43: pp 473-478
References](https://image.slidesharecdn.com/ccb06ecf-2e58-47ff-bc31-3cc588233a7e-160926161314/85/retrospective-review-of-ponv-practice-patterns-at-a-large-academic-medical-center-1-320.jpg)
