Abstract:
Background: The efficacy of postoperative nausea and vomiting (PONV) prevention
protocols in low and middle-income settings is not well known, and differences in
surgical procedures, available medications, and co-existing diseases imply that existing
protocols may need to be validated in those settings. The purpose of this study was to
determine the impact of a risk-directed PONV prevention protocol on the incidence of
PONV and short-term surgical outcomes in various resource settings.
Methods: We compared the incidence of PONV during the first 48 hours
postoperatively in the period with routine practice versus after implementation of an
Apfel score-based PONV prevention strategy among 116 adult patients undergoing
elective open abdominal surgery at Kigali University Teaching Hospital (58 patients
for each period) between April 2019 and September 2019. Time to first oral intake,
hospital length of stay, and rates of wound dehiscence were compared between the two
periods by using the chi-square and Mann-Whitney U tests accordingly.
Results: The overall pre-intervention incidence of PONV during the first 48 hours
postoperatively was 84.5% for nausea and 74.1% for vomiting. This incidence was
reduced in the post-intervention period to 31.0% for nausea (p< 0.001) and 13.8% for
vomiting (p< 0.001). The intervention was also associated with a significant reduction
in the time to first oral intake, from 24[24-36] to 17.5[12-24] hours (p< 0.001). The
hospital length of stay was also significantly lower in the post-intervention period
compared with the pre-intervention one (5[3-7] days versus 4[2-6] days; p<0.020).
Signs of wound dehiscence tended to be more observed in the pre than in the post intervention period (10.3% versus 3.5%; p<0.271) without a significant difference
Conclusion: This study has demonstrated the potential value to implement PONV
prevention protocol in resource-limited settings. Risk-directed PONV prophylaxis is
possible and effective in a low-income country and improves postoperative outcomes.
