Oct 16, 2010 - PONV/PDNV increased total cost $66 [95% CI: $36, $100]. PONV also worsened post- operative QOL: 49% of patients with PONV/PDNV rated ...
Scientific Abstracts A218 October 16, 2010 2:00:00 PM - 4:00:00 PM Room Hall B1-Area I
A Time-Motion Economic Analysis of Postoperative Nausea and Vomiting in Ambulatory Surgery ** Ivan A. Parra-Sanchez, M.D., Rania Abdallah, M.D., Jing You, M.S., Martin Grady, M.D., Daniel I. Sessler, M.D. Anesthesiology/Outcomes Research, Cleveland Clinic, Cleveland, Ohio Background: Ambulatory surgery accounts for 50-70% of surgical procedures in North America. Postoperative nausea and vomiting (PONV) is a frequent side effect which causes patient discomfort and dissatisfaction, and has a considerable medical and economic impact. More than 35% of surgical outpatients experience PONV following discharge (PDNV), at least some of whom did not experience nausea and vomiting during PACU recovery. Our goal was to determine the incremental costs of PONV in ambulatory patients over the initial three postoperative days to provide a basis for estimating the cost differences associated with the use of various antiemetic prophylactic and treatment strategies. Methods: With IRB approval, we enrolled 100 patients scheduled for ambulatory surgery lasting ≥1 hour who had at least two of the following risk factors for PONV: female gender, history of PONV or motion sickness, or non-smoking status. From the end of surgery until the third postoperative day, we evaluated the incidence of PONV, time nurses and physicians spent with patients, supplies related to PONV, recovery duration, rescue treatments for PONV, and quality-of-life (QOL). Cost from a societal perspective was considered in two time frames: the first, from the end of anesthesia until hospital discharge and the second, from hospital discharge until the third postoperative morning. We included direct and indirect costs to provide total cost from the societal perspective. Analysis of variance by ranks was conducted comparing patients with PONV/PDNV versus those without on total PONV-related cost, adjusting for ASA status, BMI, surgery duration, and complexity of surgery. Results: Thirty-seven percent of the patients experienced PONV during hospitalization, which increased to 42% and 49% by the first and third postoperative morning respectively. The incidence of new-onset late PONV, defined as new onset of PONV after hospital discharge, was 7%. The recovery duration (PACU) was significantly longer in those who experienced PONV: median [Q1,Q3] 234 [188, 285] vs 171 [144, 211] minutes, P
