Title: Postoperative Nausea and Vomit and Quality of Recovery in Cancer Patients

Background and Goal of Study:

Postoperative nausea and vomit (PONV) are the second most prevalent postoperative complication, with incidences ranging between 20 to 30%. Patients rated vomiting and nausea as the first and fourth most undesirable postoperative complications, respectively. Cancer patients are a group of patients that could have a worse recovery in the postoperative period. The aim of this study was to evaluate the incidence of PONV and its influence in the quality of recovery in a population of cancer patients.

Material and methods: 

After study approval by ethics committee, an observational prospective study was conducted. Patients submitted to elective cancer surgery with a curative intent admitted at the post anesthesia care unit (PACU) (from Jun 2016 to Oct 2016) were included. Exclusion criteria: age < 18 years old and inability to give informed consent. Patients were classified in two groups, those with and without PONV during PACU stay. Quality of Recovery was evaluated using Post-Operative Quality of Recovery Scale (PQRS) before surgery (T0), at 15 and 40 min, 24h and 72h, and Quality of Recovery-15 (QoR-15) on the day before (T0) and 24 hours (T24h) after surgery. Patient´s demographics and perioperative data were collected. The Chi-square, Fischer´s exact or Mann-Whitney U tests were used for comparisons.

Results and Discussion: 

A total of 148 patients were included in the study. The incidence of PONV was 16.2%. There were no differences in QoR-15 at TO, but at T24h patients with PONV had lower median scores in QoR-15 (105.00 vs 116.00, p=0.027), having scored lower in 5 questions in QoR-15. PQRS found no differences in overall rate of recovery in all domains evaluated together, however we found differences in respect to nociceptive (pain and nausea) domain: patients with PONV having lower scores of recovery at 40 min and 72h. In the reverse we found that PONV patients had a higher recovery in emotional (depression and anxiety) domain at 40 min, 24h and 72h. There were no differences in gender, age, ASA, body mass index (BMI), duration of anesthesia, length of PACU and hospital stay between two groups.

Conclusion (s): 

In this study QoR-15 revealed a poor quality of recovery in patients with PONV, suggesting its adverse impact in postoperative recovery. PQRS showed no differences in overall rate of recovery in all domains evaluated together but showed reversed results in respect to nociceptive and emotional domains.

Postoperative Nausea and Vomiting and Quality of Recovery in Surgical Cancer Patients