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      Risk factors of postoperative nausea and vomiting after total hip arthroplasty or total knee arthroplasty: a retrospective study

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          Abstract

          Background

          Postoperative nausea and vomiting (PONV) is a common complication after total hip/knee arthroplasty (THA/TKA) that affects patient satisfaction and postoperative recovery. It has been reported that patients undergoing THA/TKA experience PONV at a frequency of 20–83%. This study investigates the occurrence of PONV in patients and analyzes the risk factors.

          Methods

          Patients undergoing primary THA/TKA under general anesthesia from October 1, 2017, to May 1, 2018, were included. Data on patient-related factors were collected before THA/TKA. Anesthesia- and surgery-related factors were recorded postoperatively. Risk factors were analyzed using binary logistic regression.

          Results

          A stronger association of motion sickness and PONV was found at six hours after bilateral THA/TKA [nausea: odds ratio (OR) =14.648, 3.939–54.470; vomiting: OR =8.405, 2.482–28.466]. At 6–24 hours after bilateral THA/TKA, patients who had a history of migraines tended to experience nausea (OR =12.589, 1.978–80.105). Patients with lower body mass index (BMI) were more likely to experience PONV at 24–72 hours (nausea: OR =0.767, 0.616–0.954; vomiting: OR =0.666, 0.450–0.983) after bilateral THA/TKA.

          Conclusions

          The incidence of PONV after primary bilateral THA/TKA was higher than that after unilateral THA/TKA. The risk factors vary at different time points after surgery, and a history of motion sickness is the most critical factor affecting PONV.

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          Most cited references24

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          Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature

          Dissatisfaction following total knee arthroplasty (TKA) is common. Approximately 20% of patients report dissatisfaction following primary TKA. This systematic literature review explores key factors affecting patient dissatisfaction following TKA.
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            Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia

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              An update on the management of postoperative nausea and vomiting.

              Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. PONV and PDNV can delay discharge and recovery and increase medical costs. The high incidence of PONV has persisted in part because of the tremendous growth in ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major operations. Pharmacological management of PONV should be tailored to the patients' risk level using the PONV and PDNV scoring systems to minimize the potential for these adverse side effects in the postoperative period. A combination of prophylactic antiemetic drugs should be administered to patients with moderate-to-high risk of developing PONV in order to facilitate the recovery process. Optimal management of perioperative pain using opioid-sparing multimodal analgesic techniques and preventing PONV using prophylactic antiemetics are key elements for achieving an enhanced recovery after surgery. Strategies that include reductions of the baseline risk (e.g., adequate hydration, use of opioid-sparing analgesic techniques) as well as a multimodal antiemetic regimen will improve the likelihood of preventing both PONV and PDNV.
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                Author and article information

                Journal
                Ann Transl Med
                Ann Transl Med
                ATM
                Annals of Translational Medicine
                AME Publishing Company
                2305-5839
                2305-5847
                September 2020
                September 2020
                : 8
                : 17
                : 1088
                Affiliations
                [1]Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing, China
                Author notes

                Contributions: (I) Conception and design: Y Wang, X Weng; (II) Administrative support: Q Yang; (III) Provision of study materials or patients: J Lin, W Qian; (IV) Collection and assembly of data: J Jin, P Gao, B Zhang; (V) Data analysis and interpretation: Y Wang, B Feng; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                [#]

                These authors contributed equally to this work.

                Correspondence to: Bin Feng; Xisheng Weng. Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. Email: pumcfeng@ 123456163.com ; xshweng@ 123456medmail.com.cn .
                Article
                atm-08-17-1088
                10.21037/atm-20-5486
                7575972
                33145307
                c7f88eff-0987-4970-acde-e01e42409683
                2020 Annals of Translational Medicine. All rights reserved.

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                History
                : 13 July 2020
                : 25 August 2020
                Categories
                Original Article

                postoperative nausea and vomiting (ponv),total hip arthroplasty (tha),total knee arthroplasty (tka),risk factors

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