Postoperative nausea and vomiting (PONV) can be classified as: (a) early PONV (occurring within the first 2 h postoperatively), and (b) delayed PONV (occurring between 2 and 24 h postoperatively). The objectives of this study were to examine the incidence of early and delayed PONV, determine the risk factors contributing significantly to its occurrence, and develop appropriate prophylactic strategies. This prospective observational cohort study included 431 adult patients undergoing elective surgery. The risk factors were categorised into four categories: patient-related (individual), surgery-related factors, anaesthesia- and drug-related factors, and postoperative factors. Patients were treated across five different surgical specialties. Early PONV occurred in 18.8% of patients (n = 81), while delayed PONV occurred in 18.3% (n = 79). The main independent contributors to early PONV were female gender, BMI > 25 kg/m2, history of motion sickness, chronic renal insufficiency (CRI), postoperative opioid use, and postoperative hypotension. Factors contributing to delayed PONV included female gender and a history of motion sickness. Gynaecological procedures were associated with the highest risk for both early and delayed PONV. The incidence of early PONV was highest in gynaecology patients (31.8% of 85 gynaecology patients, n = 27), while delayed PONV was most prevalent among gynaecology and general surgery patients. Significant risk factors for early PONV included female gender, BMI > 25 kg/m2, history of motion sickness, CRI, postoperative opioid use, and hypotension. For delayed PONV, female gender and motion sickness history remained the primary factors. Prophylaxis for early PONV should focus on precise drug dosing and maintaining haemodynamic stability by avoiding hypotension; conversely, delayed PONV prevention should prioritise minimising opioid analgesics.
Lakićević et al. (2026) studied this question.