Patterns and Risk Factors Associated with Postoperative Nausea and Vomiting Among Surgical Patients
DOI:
https://doi.org/10.68041/jmmhr.v1i2/03Keywords:
Analgesics, Opioid, Anesthesia, General, Antiemetics, Postoperative Nausea and Vomiting, Risk FactorsAbstract
Background: Postoperative nausea and vomiting (PONV) is a frequent complication of surgery and anesthesia that may negatively impact comfort and early recovery. This study aimed to determine the prevalence and pattern of PONV and identify patient-, anesthetic-, and surgery-related factors independently associated with its occurrence. Methods: This is a descriptive cross-sectional study conducted on 180 adults who were undergoing elective/emergency surgery under general or regional anesthesia for 6 months. Data were collected by patient interviews, anesthesia records, and hospital records on a structured form and included all the demographic, clinical, anesthetic, surgical, and postoperative data. Nausea and vomiting within the first 24 hours of surgery were recorded. SPSS version 26.0 was used for statistics, association tests and multivariable logistic regression to identify risk factors independently associated with PONV and a p-value <0.05 was considered statistically significant. Results: The mean age was 45.9 ± 14.7 years, and 55.6% were female. Overall, 37.8% developed PONV, of which 21.7% suffered from nausea alone, 6.1% from vomiting alone, and 10.0% from both. Independent predictors were previous PONV (aOR=3.24; p=0.002), female sex (aOR=2.89; p=0.001), general anesthesia (aOR=2.71; p=0.008), postoperative opioid use (aOR=2.58; p=0.004), surgery duration ≥2 hours (aOR=2.36; p=0.011), and non-smoking status (aOR=2.14; p=0.047). Conclusion: More than one-third of patients experienced PONV, and factors were identified which were affecting PONV. Optimized anesthetic care, opioid-sparing analgesia, and risk-based antiemetic prophylaxis can lower the risk of PONV. These results could be confirmed and approaches for optimizing postoperative comfort, safety, and recovery explored by future multicentered research.
References
1. Shaikh SI, Nagarekha D, Hegade G, Marutheesh M. Postoperative nausea and vomiting: a simple yet complex problem. Anesth Essays Res. 2016;10(3):388–396. https://doi.org/10.4103/0259-1162.179310 DOI: https://doi.org/10.4103/0259-1162.179310
2. Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020;131(2):411–448. https://doi.org/10.1213/ANE.0000000000004833 DOI: https://doi.org/10.1213/ANE.0000000000004833
3. Gress K, Urits I, Viswanath O, Urman RD. Clinical and economic burden of postoperative nausea and vomiting: analysis of existing cost data. Best Pract Res Clin Anaesthesiol. 2020;34(4):681–686. https://doi.org/10.1016/j.bpa.2020.07.003 DOI: https://doi.org/10.1016/j.bpa.2020.07.003
4. Zhao X, Liao W, Chen C, Zheng Y, Li L, Chang Q, et al. Postoperative nausea and vomiting: translating pathophysiological mechanisms into clinical management. Perioper Med (Lond). 2025;14(1):140. https://doi.org/10.1186/s13741-025-00626-5 DOI: https://doi.org/10.1186/s13741-025-00626-5
5. Darvall J, Handscombe M, Maat B, So K, Suganthirakumar A, Leslie K. Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score: an analysis of published studies. Can J Anaesth. 2021;68(7):1057–1063. https://doi.org/10.1007/s12630-021-01974-8 DOI: https://doi.org/10.1007/s12630-021-01974-8
6. Schlesinger T, Meybohm P, Kranke P. Postoperative nausea and vomiting: risk factors, prediction tools, and algorithms. Curr Opin Anaesthesiol. 2023;36(1):117–123. https://doi.org/10.1097/ACO.0000000000001220 DOI: https://doi.org/10.1097/ACO.0000000000001220
7. Roh YH, Park SG, Lee SH. Regional versus general anesthesia in postoperative pain management after distal radius fracture surgery: a meta-analysis of randomized controlled trials. J Pers Med. 2023;13(11):1543. https://doi.org/10.3390/jpm13111543 DOI: https://doi.org/10.3390/jpm13111543
8. Andrew BY, Holmes R, Taicher BM, Habib AS. The association of guideline-directed prophylaxis with postoperative nausea and vomiting in adult patients: a single-center, retrospective cohort study. Anesth Analg. 2024;139(5):1006–1016. https://doi.org/10.1213/ANE.0000000000006855
9. Weibel S, Rücker G, Eberhart LHJ, Pace NL, Hartl HM, Jordan OL, et al. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis. Cochrane Database Syst Rev. 2020;10(10):CD012859. https://doi.org/10.1002/14651858.CD012859.pub2 DOI: https://doi.org/10.1002/14651858.CD012859.pub2
10. Sullivan KM, Dean A, Soe MM. OpenEpi: a web-based epidemiologic and statistical calculator for public health. Public Health Rep. 2009;124(3):471–474. https://doi.org/10.1177/003335490912400320 DOI: https://doi.org/10.1177/003335490912400320
11. Laufenberg-Feldmann R, Müller M, Ferner M, Engelhard K, Kappis B. Is ‘anxiety sensitivity’ predictive of postoperative nausea and vomiting? A prospective observational study. Eur J Anaesthesiol. 2019;36(5):369–374. https://doi.org/10.1097/EJA.0000000000000979 DOI: https://doi.org/10.1097/EJA.0000000000000979
12. Jabir, Thirumaaran UG, Pavithran, Murali G. Incidence of postoperative nausea and vomiting in patients following general anaesthesia. Int J Drug Deliv Technol. 2026;16(12 Suppl):460–464. https://doi.org/10.25258/ijddt.16.12s.56 DOI: https://doi.org/10.25258/ijddt.16.12s.56
13. Choi DH, Ko JS, Ahn HJ, Kim JA. A Korean predictive model for postoperative nausea and vomiting. J Korean Med Sci. 2005;20(5):811–815. https://doi.org/10.3346/jkms.2005.20.5.811 DOI: https://doi.org/10.3346/jkms.2005.20.5.811
14. Sinha V, Vivekanand D, Singh S. Prevalence and risk factors of post-operative nausea and vomiting in a tertiary-care hospital: a cross-sectional observational study. Med J Armed Forces India. 2022;78(Suppl 1):S158–S162. https://doi.org/10.1016/j.mjafi.2020.10.024 DOI: https://doi.org/10.1016/j.mjafi.2020.10.024
15. Ishikawa E, Iwamoto R, Hojo T, Teshirogi T, Hashimoto K, Shibuya M, et al. Cross-sectional study of PONV risk factors for oral surgery after intubated general anesthesia with total intravenous anesthesia. Anesth Prog. 2022;69(1):18–23. https://doi.org/10.2344/anpr-68-03-12 DOI: https://doi.org/10.2344/anpr-68-03-12
16. Johansson E, Hultin M, Myrberg T, Walldén J. Early postoperative nausea and vomiting: a retrospective observational study of 2030 patients. Acta Anaesthesiol Scand. 2021;65(9):1229–1239. https://doi.org/10.1111/aas.13936 DOI: https://doi.org/10.1111/aas.13936
17. Son J, Yoon H. Factors affecting postoperative nausea and vomiting in surgical patients. J Perianesth Nurs. 2018;33(4):461–470. https://doi.org/10.1016/j.jopan.2016.02.012 DOI: https://doi.org/10.1016/j.jopan.2016.02.012
18. Dhakal R, Upadhya PS, Luitel P, Pariyar S, Koirala BH, Kandel S. Incidence and predictors of postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective observational study in Nepal. J Minim Invasive Surg. 2025;28(3):130–136. https://doi.org/10.7602/jmis.2025.28.3.130 DOI: https://doi.org/10.7602/jmis.2025.28.3.130
19. Ju JW, Kwon J, Yoo S, Lee HJ. Retrospective analysis of the incidence and predictors of postoperative nausea and vomiting after orthopedic surgery under spinal anesthesia. Korean J Anesthesiol. 2023;76(2):99–106. https://doi.org/10.4097/kja.22237 DOI: https://doi.org/10.4097/kja.22237
20. Andrew BY, Holmes R, Taicher BM, Habib AS. The association of guideline-directed prophylaxis with postoperative nausea and vomiting in adult patients: a single-center, retrospective cohort study. Anesth Analg. 2024;139(5):1006–1016. https://doi.org/10.1213/ANE.0000000000006855 DOI: https://doi.org/10.1213/ANE.0000000000006855
21. Dewinter G, Staelens W, Veef E, Teunkens A, Van de Velde M, Rex S. Simplified algorithm for the prevention of postoperative nausea and vomiting: a before-and-after study. Br J Anaesth. 2018;120(1):156–163. https://doi.org/10.1016/j.bja.2017.08.003 DOI: https://doi.org/10.1016/j.bja.2017.08.003
22. Tabrizi S, Malhotra V, Turnbull ZA, Goode V. Implementation of postoperative nausea and vomiting guidelines for female adult patients undergoing anesthesia during gynecologic and breast surgery in an ambulatory setting. J Perianesth Nurs. 2019;34(4):851–860. https://doi.org/10.1016/j.jopan.2018.10.006 DOI: https://doi.org/10.1016/j.jopan.2018.10.006
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Fatima Qayyum, Nida Shahid, Ahmed Al Nasar

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Medical and Multidisciplinary Healthcare Research (JMMHR) follows the Attribution Creative Commons-Non commercial (CC BY-NC 4.0) license which allows the users to copy and redistribute the material in any medium or format, remix, transform and build upon the material. The users must give credit to the source and indicate, provide a link to the license, and indicate if changes were made. However, the CC BY-NC 4.0 license restricts the use of material for commercial purposes (Further details are available at website. The Editorial Board of the JSAMR endeavors to ensure the accuracy, integrity, and quality of all published content. However, the responsibility of opinions, interpretations, and conclusions expressed in the published articles rests entirely with the authors and do not necessarily reflect the views of the Editorial Board, publisher, or affiliated institutions.