A time-motion economic analysis of postoperative nausea and vomiting in ambulatory surgery Une analyse économique des temps et mouvements pour les nausées et vomissements postopératoires en chirurgie d’un jour

Background One-third of surgical outpatients experience postoperative nausea and vomiting (PONV) during their hospital stay or post-discharge nausea and vomiting (PDNV) after hospitalization. We determined the incremental costs of PONV/PDNV in ambulatory patients with this time-and-motion study. Methods In 100 ambulatory surgery patients, we evaluated the incidence of PONV, time staff spent with patients, use of PONV-related supplies, recovery duration, PONV rescue treatments, and quality-of-life through to the third postoperative morning. Patients with and without PONV/ PDNV were compared in relation to PONV-related cost after adjusting for age, American Society of Anesthesiologists status, body mass index, and duration and complexity of surgery. Results Thirty-seven percent of the patients experienced PONV during hospitalization; this increased to 42% by the first postoperative morning and increased further to 49% by the third postoperative morning. Patients with PONV spent one hour longer in the postanesthesia care unit than patients without PONV (median [interquartile range] 234 [188-287] min vs 171 [144-212] min, respectively; P = 0.001). The amount of nursing time required for patients with PONV was significantly greater than that required for patients without PONV (82 [63-106] min vs 68 [57-79] min, respectively; P = 0.02). The total cost of postoperative recovery was significantly greater for patients with PONV/PDNV than for those without (US$730 vs $640, respectively; P = 0.006). Postoperative nausea and vomiting/PDNV was associated with an adjusted incremental total cost of $75 (95% confidence interval $67 to $86). Postoperative nausea and vomiting was also associated with worsened postoperative quality of life (49% of patients with PONV/PDNV rated quality high in four domains vs 94% of patients without PONV/PDNV; P \ 0.001). Conclusion Postoperative nausea and vomiting/PDNV were common; they impaired quality of life and imposed an incremental cost of $75 per patient. This incremental cost is comparable with the cost patients are willing to pay to avoid PONV. Author contributions Ivan Parra-Sanchez contributed to the conduct of the study, analyzed the data, and helped write the manuscript. Rania Abdallah helped conduct the study. Jing You helped design the study, analyze the data, and write the manuscript. Alex Fu contributed to the study design and data analysis. Martin Grady helped conduct the study. Kenneth Cummings helped conduct the study. Christian Apfel helped design the study and write the manuscript. Daniel Sessler helped design the study, analyze the data, and write the manuscript. I. Parra-Sanchez, MD R. Abdallah, MD J. You, MS M. Grady, MD K. Cummings III, MD D. I. Sessler, MD (&) Department of Outcomes Research, Anesthesiology Institute, The Cleveland Clinic—P77, Cleveland, OH 44195, USA e-mail: ds@or.org URL: www.or.org J. You, MS A. Z. Fu, PhD Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA M. Grady, MD K. Cummings III, MD General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA C. Apfel, MD Department of Anesthesia, University of California, San Francisco, CA, USA D. I. Sessler, MD Population Health Research Institute, McMaster University, Hamilton, ON, Canada 123 Can J Anesth/J Can Anesth (2012) 59:366–375 DOI 10.1007/s12630-011-9660-x