Almost 1 in 5 surgical patients experience postoperative nausea and vomiting (PONV), placing a substantial burden on healthcare systems.
A recent study analysed the incidence and predictors of PONV in adult surgical patients at Dubai Hospital, shedding light on key risk factors and the impact of preventive measures.
It examined this issue using real-world hospital data from 1,113 adult patients who underwent inpatient surgery under general anaesthesia at Dubai Hospital between January 2024 and September 2025.
The results showed that 17.9% of patients (around 1 in 5) experienced PONV within 24 hours of their operation. This rate is at the lower end of the global range (typically 20% to 30%), but it still represents a meaningful burden.
Patients who developed PONV were generally older, had more complex underlying health conditions, scored higher on the standard PONV risk scale used by anaesthetists (the Apfel score), and spent longer under anaesthesia than those who did not.
Using a multivariable statistical model to control for confounding factors, the study identified two key independent predictors of PONV: female sex and a higher Apfel score – a four-point scale that incorporates patient-specific risk factors, including sex, smoking history, prior episodes of PONV or motion sickness, and anticipated use of postoperative opioids.
Female patients were 1.5 times more likely to develop PONV than male patients. Each additional point on the Apfel score increased the odds by 1.2 times.
The type of volatile anaesthetic, surgery duration, body weight, and health classification weren’t significant once patient-level factors were considered. This highlights that PONV risk mainly depends on the patient, not just on drugs or techniques.
The study also found that the type of surgery mattered considerably: kidney surgeries had the highest PONV rate at 39.3%, followed by gastrointestinal procedures at 26.3%, while gynaecological surgeries had the lowest at just 5.5%.
When anti-nausea drugs were given during the operation (95.4% of patients), the PONV rate was 16.9%, compared with 39.2% in the small group who received none, confirming that intraoperative prophylaxis makes a significant difference.
Dubai Hospital’s policy requires all patients undergoing general anaesthesia to receive two anti-nausea medications during surgery: ondansetron and dexamethasone.
While 91.7% of patients received ondansetron and 87.5% received dexamethasone, only 75.8% received both together as the policy requires – so around 1 in 4 patients did not receive the full recommended protection.
The most common reason for omitting dexamethasone was concern about blood sugar spikes in diabetic patients, a clinically understandable but protocol-deviating choice that highlights the tension between individual clinical judgement and standardised care.
The authors argue that closing this adherence gap through staff education, regular clinical audits, and updated guidance for managing diabetic patients could meaningfully reduce PONV rates.
They also acknowledge the study’s limitations: its retrospective, single-centre design means the results may not translate directly to hospitals with different protocols, and mild or short-lived nausea may have been under-recorded in nursing records.
The study was published in The Open Anesthesia Journal.
