Incidence and risk factors for postoperative nausea and vomiting following video-assisted thoracoscopic surgery: a prospective observational study

Background Postoperative nausea and vomiting (PONV) is a common complication after general anesthesia, contributing to patient discomfort, adverse clinical outcomes, and increased healthcare costs. While video-assisted thoracoscopic surgery (VATS) offers substantial benefits over open procedures, data on the incidence and predictors of PONV specifically following VATS are scarce and predominantly derived from retrospective studies. This study aimed to prospectively determine the incidence and identify independent risk factors for PONV within the first 72 h after VATS. Methods In this single-center, prospective observational study, we enrolled 355 adult patients (aged ≥ 18 years) who underwent VATS under general anesthesia at Peking University Third Hospital between September 2022 and September 2023. PONV was assessed in the post-anesthesia care unit (PACU) within 2 h postoperatively and then daily on the ward for three consecutive days. The primary outcome was the incidence of PONV within 72 h. Multivariate logistic regression was employed to identify independent risk factors, with a P -value 0.05 deemed statistically significant. Results The overall incidence of PONV within 72 h was 19.44% (69/355). PONV was significantly more frequent in female patients (84.06% of PONV cases) than in males (15.94%, P 0.001). The highest incidence occurred in the PACU (17.96%), followed by the day of surgery (7.89%) and postoperative day 1 (POD1, 7.61%) on the ward. The incidence decreased to 0.85% on POD2 and 1.41% on POD3. The most severe PONV episodes were reported on the day of surgery (17.86% of PONV cases) and on POD1 (22.22%). Multivariate analysis identified four independent risk factors: female gender, preoperative erector spinae plane block (ESPB), non-administration of preoperative steroids, and low intraoperative minimum mean arterial pressure (MAP). Conclusion Approximately one in five patients experienced PONV within 72 h after VATS. Independent risk factors included female gender, preoperative ESPB, omission of preoperative steroid prophylaxis, and low intraoperative minimum MAP. These findings highlight potential targets for risk stratification and optimized PONV prophylaxis in this surgical population.