Postoperative Nausea and Vomiting Prevention in Patients Undergoing Spinal Surgery

Abstract

Problem & Purpose: The postoperative nausea and vomiting rates at a university teaching hospital have consistently been 3.5-5% higher than the medical system’s average. Postoperative nausea and vomiting can lead to an increased length of hospital stay and thus increased cost to the hospital. Severe complications include suture dehiscence, esophageal rupture, aspiration, dehydration, and electrolyte imbalances. The purpose of this quality improvement project is to implement and evaluate the effectiveness of the Modified Apfel screening tool and subsequent prophylactic treatment in adults undergoing elective spinal surgery at a large university teaching hospital. Methods: A Modified Apfel screening tool and a corresponding prophylactic treatment guideline were made available to all anesthesia providers at a large university teaching hospital. Anesthesia providers used the tools to screen for postoperative nausea and vomiting risk and provided prophylactic treatment to adult elective spinal surgery patients. The risk scores were documented within the anesthesia record. Compliance with screening, prophylactic treatment, and postoperative nausea and vomiting occurrences were tracked via chart audits. Results: Chart audits were completed for 550 spinal surgery patients over a 15-week period. Median anesthesia provider compliance with Modified Apfel tool screening, and prophylactic treatment for a Modified Apfel score greater than or equal to three, was 54.5% and 69%, respectively. The median percentage of spinal surgery patients not requiring an antiemetic within 24 hours of surgery improved from 82.7% (baseline) to 88.4%. Conclusions: The implementation of the Modified Apfel screening tool and prophylactic treatment guideline is a feasible and sustainable intervention. Provider compliance with screening and treatment leads to lower postoperative nausea and vomiting rates. Incorporating screening tools into the preoperative assessment is an important practice for anesthesia providers.