Factors Associated with Postoperative Nausea and Vomiting in Patients Undergoing an Ambulatory Hand Surgery

Ambulatory surgeries account for an increasing share of all surgical procedures. More than 60% of all surgeries in the US and Europe are performed in ambulatory settings, and in particular, hand and wrist surgeries have shown an increasing trend.1,2,3) Advances in less invasive surgical techniques, the use of short-acting general anesthetics and the cost-effectiveness of ambulatory surgeries have contributed to an increasing number of surgeries performed in ambulatory settings.4) The perioperative care for a patient's quality of life is an important concern in an ambulatory surgery.5) However, many patients undergoing ambulatory surgery under general anesthesia experience unacceptable levels of nausea and vomiting (N/V) after surgery.6,7) Although ambulatory patients are less likely to experience postoperative N/V than inpatients, this could be partly explained by an under-recognition of postdischarge N/V because ambulatory patients are not under direct medical supervision after their discharge.8) Most of hand surgeries can be performed under regional anesthesia, thus they are not typically thought to result in a high incidence of postoperative N/V.9,10) However, considerable parts of hand surgeries are still being performed under general anesthesia and a study reported up to 32% incidence of postoperative N/V after ambulatory hand surgeries under general anesthesia.11) A number of studies have addressed postoperative N/V in areas such as gynecological,9) abdominal,10) ears, nose and throat,12) or arthroplastic surgery of the knee.13) However, incidences of those events are known to be influenced by the type of surgical procedure,6,14) as the surgical location, such as abdominal surgery or a head and neck (near the ear) surgery can affect N/V levels. Also patients undergoing lower extremity surgeries that require admission may get a better treatment of their N/V. Furthermore, few studies have comprehensively evaluated factors associated with postoperative N/V in ambulatory hand surgeries. Therefore, we investigated factors associated with postoperative N/V in patients undergoing an ambulatory hand surgery under general anesthesia and determined whether patients' satisfaction with this setting is associated with postoperative N/V levels.