Risk factors of postoperative nausea and vomiting in patients undergoing robot-assisted radical pros-tatectomy
Objective To explore the incidence and associated factors of postoperative nausea and vomiting(PONV)after robot-assisted radical prostatectomy(RARP).Methods A retrospective collection of 622 male patients undergoing RARP,aged 18-90 years,ASA physical status Ⅱ or Ⅲ,was per-formed.Information on history of underlying diseases,fasting time,and ASA classification were collect-ed.During the surgery,the surgical and anesthesia duration,fluid intake and output,medications used dur-ing anesthesia,and times of using antihypertensive and vasopressor drugs were recorded.Postoperative data within 24 hours encompassed the patient's whereabouts,presence of dizziness and headache,use of proton pump inhibitors,use of analgesic medications,incision pain score,and the postoperative length of stay.Pa-tients were divided into two groups;PONV group and non-PONV group according to whether PONV existed within 24 hours after RARP.Multivariate logistic regression analysis was used to explore the risk factors of PONV within 24 hours after RARP.The area under the receiver operating characteristic curve(AUC)and 95%confidence interval(CI)were used to evaluate the discriminative efficacy of multivariate logistic re-gression analysis.Results Sixty-seven cases(10.8%)of patients with RARP suffered from PONV within 24 hours after surgery.Compared with the non-PONV group,the PONV group had significantly lower rates of BMI,intraoperative use of dexamethasone,and postoperative proton pump inhibitor use(P＜0.05),and significantly higher proportions of history of cerebrovascular disease,postoperative dizziness,administration of paracetamol and tramadol hydrochloride tablets,and incisional pain(P＜0.05).Multifactorial logistic regression analysis showed that higher BMI(OR=0.900,95%CI 0.818-0.990,P=0.030)and intra-operative ues of dexamethasone(OR=0.945,95%CI 0.894-0.999,P=0.047)were significantly and negatively correlated with the prevalence of PONV during the postoperative period 24 hours in patients with RARP.History of cerebrovascular disease(OR=3.788,95%CI 1.501-9.558,P=0.005),dizziness within 24 hours after surgery(OR=4.191,95%CI 2.111-8.320,P＜0.001)and postoperative incision pain(OR=3.881,95%CI 1.175-12.821,P=0.026)were significantly and positively corre-lated with the incidence of PONV.The history of cerebrovascular disease was an independent risk factor for the development of PONV within 24 hours postoperatively in patients with RARP,with an AUC of 0.539(95%CI 0.462-0.616),a cutoff value of 0.5,a sensitivity of 11.9%,and a specificity of 95.9%.The combined prediction of BMI,diabetes mellitus,history of cerebrovascular disease,intraoperative use of dex-amethasone,postoperative dizziness,taking paracetamol and tramadol hydrochloride tablets,taking proton pump inhibitors,and incisional pain had an AUC for PONV of 0.739(95%CI 0.674-0.804),a cutoff value of 0.1,a sensitivity of 68.7%,and a specificity of 67.4%.Conclusion History of cerebrovascular disease was an independent risk factor for PONV in RARP patients within 24 hours postoperatively,dizziness and incisional pain within 24 hours postoperatively were significantly associated with PONV,and higher BMI and intraoperative use of dexamethasone can significantly reduce the incidence of PONV.
Postoperative nausea and vomitingLaparoscopicRobot-assisted radical prostatecto-myHistory of cerebrovascular diseaseRisk factor
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