Does Management of Postoperative Nausea and Vomiting Differ by Patient Demographics? An Evaluation of Perioperative Anesthetic Management - An Observational Study.

Background: Disparities in postoperative nausea and vomiting (PONV) and its prophylaxis may exist based on race, ethnicity, and socioeconomic status (SES). Our objective was to evaluate whether patients from racial and ethnic minority groups and patients from lower SES backgrounds received less appropriate PONV prophylaxis and experienced higher rates of PONV and post-discharge nausea and vomiting (PDNV).

Methods: This retrospective cohort study included 23,333 adults who underwent major surgeries (total knee arthroplasty, cholecystectomy, hysterectomy, and prostatectomy) from 2017-2022 in a single, multi-state hospital system. Outcomes included prophylactic antiemetic administration according to consensus guidelines as well as occurrence of PONV and PDNV, with predictors being patient race and ethnicity, payor type, and community-level SES.

Results: About 45% (n=10,407) of patients received guideline-recommended PONV prophylaxis. Regression models showed statistically significant differences in appropriate PONV prophylaxis by race and ethnicity as well as community-level SES, with Black (OR=0.76; 95% CI: 0.63, 0.92) and Hispanic (OR=0.82; 95% CI: 0.70, 0.96) patients having lower odds of receiving appropriate antiemetic prophylaxis compared to non-Hispanic White patients. Approximately 11% of patients (n=2522) experienced PONV in the Post-Anesthesia Care Unit (PACU), and about 19.5% of patients (n=4540) experienced PDNV. No significant differences in PONV were observed in the PACU among different groups, however, Black, Hispanic, Other races and ethnicities, and patients with Medicaid had higher odds of PDNV.

Conclusion: The study identified differences in appropriate PONV prophylaxis by race and ethnicity as well as community-level SES. There were no differences in PONV by our predictors, but higher odds of PDNV by race and ethnicity and payor. This study underscores the importance of data stratification in quality measures to identify disparities in perioperative care; it can lead to changes in perioperative anesthetic management. Further research should explore these associations in a broader cohort and address potential confounding sources.