Evaluation of risk factors affecting postoperative nausea and vomiting

ABSTRACT EVALUATION OF RISK FACTORS AFFECTING POSTOPERATIVE NAUSEA AND VOMITING The aim of this descriptive study was to investigate of the nausea and vomiting occurring in the postoperative period. The research was conducted between 01.06.2016 and 31.07.2016 at Ege University Medical Faculty Hospital General Surgery Department, Chest Surgery Department, Cardiovascular Surgery Department, Ear Nose Throat Department, Neurosurgery Department, Orthopedics and Traumatology Department, Plastic Reconstructive and Aesthetic Surgery Department, Urology Department and Organ Transplant Research and Application Center. The sample of the research was constituted 242 volunteer conscious patients over 18 years old and American Society of Anesthesiologist (ASA) I-II classification criteria underwent surgery between 01.06.2016 and 31.07.2016 at Ege University Medical Faculty Hospital's 9 surgical clinics. Data were collected after receiving the written consent of the investigator to inform the patient about the issue of researching the patient at the appropriate time to the operation with patients files were collected and face to face technique in the first 24 hours after operation. After Information and Consent Form, used the questionnaire form that was 'Patient Presentation Form' prepared in the direction of literature and 'Patient Evaluation Form' containing preoperative and postoperative evaluations. Patient Presentation Form was used to evaluate the patient's clinical knowledge, age, gender, height, weight, Body Mass Index (BMI), education status, marital status, social security, addiction, smoking and alcohol use, nausea and vomiting during the trip, surgical interventions, experience of nausea and vomiting after previous surgical interventions, and evaluation of these attempts. Patient Evaluation Form; premedication practice, anxiety / fear / worry related to operation, pre-operative fasting period, pre-operative narcotic, antibiotic and antiemetic use will be questioned. The Apfel Nausea Vomiting Risk Score including risk factors such as female gender, postoperative nausea and vomiting narrative or vehicle retention story, smoking cessation, postoperative opioid use and duration of surgery> 60 minutes, female gender, preoperative findings of the patient were evaluated using Koivuranta Nausea Vomiting Risk Score including postoperative nausea vomiting, smoking risk factors. The location of the operation, the duration of the operation, the anesthetic agents used, the treatment applied for pain, the time of oral intake after the operation, the length of stay in the intensive care unit / separation unit, postoperative posture, postoperative nausea and vomiting, the duration of the surgery, the duration of the treatment, the treatment applied to the nausea, whether or not the drug is used / used for the nausea, vomiting, whether or not it is gumming, the first 2 hours after surgery, 3-6 hours after surgery, the severity of pain during activity, the intensity of rest pain, the level of anxiety / anxiety / horror, the severity of fatigue, the severity of bulanitis, the worst severity of bulanitis, the severity of pain during activity, the severity of pain during activity nausea severity, the severity of nausea, the severity of sickness / vomiting, and the worst severity of retching / vomiting. Data were analysed using the SPSS for Windows 22.0 package program. It was used descriptive statistics, Shapiro Wilk test for intergroup comparisons of normal distribution parameters. Kruskal Wallis-H test, Spearman Correlation Analysis, Pearson Chi-Square and Fisher's exact Chi-Square analyses for cross tabulations. A p value of <0.05 was considered statistically significant for all outcomes. At the end of the study, 45.9% (n=111) of the patients were experiencing nausea, 46.9% (n=52) of the patients who had nausea in the postoperative period had 2 nausea, 92.8% (n=103) of the nausea lasted 0-5 minutes, 99.1% (n=110) were had nausea of varying quality. 81.1% (n=90) of the patients who had nausea in the postoperative period did not use medication after nausea. It was found that 23.6% (n=57) of the patients included in the study had vomiting, 54.4% (n=31) of vomiting patients were found to have been vomited for 1 time. The mean Apfel risk score of the patients included in the study was 1.88 + 1.16 (min:0, max:4). The mean Koivuranta risk score of the patients included in the study was 2.35 + 1.07 (min:0, max:5). According to the Kruskal Wallis-H Test results; a statistically significant difference was found between the postoperative nausea and vomiting and the use of the Apfel risk score (x2: 36.301, 35.302, p:0.000). According to the Kruskal Wallis-H Test results; a statistically significant difference was found between the postoperative nausea and vomiting and the use of the Koivuranta risk score (x2: 36.552, 36.523, p:0.000). There was no significant relationship between the sex of patients and postoperative nausea (x2: 2.133, p:0.144), was found to be significantly associated with postoperative vomiting (x2: 11.134, p:0.001). There was a significant correlation between nonsmoking status and postoperative nausea (x2: 9.089, p:0.003), were not significantly associated with postoperative vomiting (x2: 2.900, p:0.089). There was a significant correlation between patients' additional disease and postoperative nausea (x2: 10.020, p:0.002), were not significantly associated with postoperative vomiting (x2: 1.231, p:0.267). There was a significant correlation between history of motion sickness and postoperative nausea (x2: 21.358, p:0.000), was found to be significantly associated with postoperative vomiting (x2: 12.513, p:0.000). There was a significant correlation between patients' previous surgery and postoperative nausea (x2: 6.935, p:0.008), was found to be significantly associated with postoperative vomiting (x2: 2.339, p:0.126). There was no significant relationship between history of postoperative nausea and vomiting and postoperative nausea (x2: 1.306, p:0.253), was found to be significantly associated with postoperative vomiting (x2: 10.542, p:0.001). There was a significant correlation between preoperative anxiety-fear and postoperative nausea (x2: 27.894, p:0.000), was found to be significantly associated with postoperative vomiting (x2: 12.407, p:0.000). There was no significant correlation between operative duration of patients and postoperative nausea (x2: 2.100, p:0.224), were not significantly associated with postoperative vomiting (p:0.174). There was no significant correlation between anesthesia type and postoperative nausea (x2: 0.000, p:1.000), was found to be significantly associated with postoperative vomiting (x2: 5.476, p:0.019). There was no significant correlation between opioid use during surgery and postoperative nausea (x2: 0.808, p:0.369), were not significantly associated with postoperative vomiting (x2: 1.853, p:0.173). There was a significant correlation between opioid use after surgery and postoperative nausea (x2: 18.051, p:0.000), was found to be significantly associated with postoperative vomiting (x2: 20.285, p:0.00). As a result, patients have experienced postoperative nausea and/or vomiting, postoperative nausea and vomiting is influenced by specific factors to the patient and anesthesia and results of Apfel and Koivuranta risk scores, it was determined that the risk of postoperative nausea and vomiting risk in early stage of the patients can be determined. Key words: Nausea and vomiting, postoperative nausea and vomiting, nursing