Preoperative multimodal protocol reduced postoperative nausea and vomiting in patients undergoing mastectomy with reconstruction. Issue 2 (February 2022)

• Record Type: Journal Article
• Authors: Serpico, Victoria J.; Mone, Mary C.; Zhang, Chong; Presson, Angela P.; Killian, Heather; Agarwal, Jayant; Matsen, Cindy B.; Porretta, Jane; Nelson, Edward W.; Junkins, Scott
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 75:Issue 2(2022)
• Page Start: 528
• Page End: 535
• Publication Date: 2022-02
• Subjects: Multimodal medication -- Postoperative nausea and vomiting (PONV) -- Mastectomy -- Reconstructive breast surgery -- Standardized preoperative protocol -- Women's health; Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2021.09.059
• Languages: English
• ISSNs: 1748-6815

Abstract

Summary: Background: Mastectomy with immediate reconstruction is a high-risk cohort for postoperative nausea and vomiting (PONV). Known risk factors for PONV include female gender, prior PONV history, nonsmoker, age < 50, and postoperative opioid exposure. The objective of this observational, cohort analysis was to determine whether a standardized preoperative protocol with nonopioid and anti-nausea multimodal medications would reduce the odds of PONV. Methods: After IRB approval, retrospective data were collected for patients undergoing mastectomy with or without a nodal resection, and immediate subpectoral tissue expander or implant reconstruction. Patients were grouped based on treatment: those receiving the protocol - oral a cetaminophen, p regabalin, c elecoxib, and transdermal s copolamine (APCS); those receiving none (NONE), and those receiving partial protocol (OTHER). Logistic regression models were used to compare PONV among treatment groups, adjusting for patient and procedural variables. Main Findings: Among 305 cases, the mean age was 47 years (21–74), with 64% undergoing a bilateral procedure and 85% having had a concomitant nodal procedure. A total of 44.6% received APCS, 30.8% received OTHER, and 24.6% received NONE. The APCS group had the lowest rate of PONV (40%), followed by OTHER (47%), and NONE (59%). Adjusting for known preoperative variables, the odds of PONV were significantly lower in the APCS group versus the NONE group (OR=0.42, 95% CI: 0.20, 0.88 p = 0.016). Conclusions: Premedication with a relatively inexpensive combination of oral non-opioids and an anti-nausea medication was associated with a significant reduction in PONV in a high-risk cohort. Use of a standardized protocol can lead to improved care while optimizing the patient experience.