Post-surgery nausea and vomiting remains a real problem – even when preventive drugs are given. A new study explains why

Waking up from surgery feeling nauseous or vomiting is one of the most distressing experiences a patient can have — and one that patients consistently rank as worse than pain itself. Despite decades of progress in anesthesia and the wide availability of anti-nausea drugs, postoperative nausea and vomiting (PONV) continues to affect a significant proportion of surgical patients worldwide.

Nearly 1 in 5 Surgical Patients Still Experienced Nausea or Vomiting After Their Operation

A new study published in The Open Anesthesia Journal examined this problem using real-world hospital data from 1,113 adult patients who underwent inpatient surgery under general anesthesia at Dubai Hospital between January 2024 and September 2025. The results showed that 17.9% of patients — roughly 1 in 5 — experienced PONV within 24 hours of their operation, a rate that is on the lower end of what has been reported globally (where figures typically range from 20% to 30%), but still 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 anesthetists (the Apfel score), and spent longer time under anesthesia than those who did not.

Being Female and Having a Higher Risk Score Were the Strongest Predictors — More So Than the Drugs Used or the Type of Anesthetic

When the researchers applied a multivariable statistical model to strip away confounding factors and identify what most independently predicted PONV, two variables rose clearly above the rest: being female, and having a higher Apfel score — a four-point scale that weighs known patient risk factors including sex, smoking history, previous experience of PONV or motion sickness, and the likely use of opioid painkillers after surgery. 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 a further 1.2 times. Notably, the type of volatile anesthetic agent used, the duration of surgery, body weight, and the patient’s overall health classification were not independently significant once these two patient-level factors were accounted for. This is a meaningful finding because it places the locus of PONV risk firmly in who the patient is — not just in the drugs or techniques chosen. The study also found that the type of surgery mattered considerably: kidney surgeries carried the highest PONV rate at 39.3%, followed by gastrointestinal procedures at 26.3%, while gynecological surgeries had the lowest at just 5.5%. When anti-nausea drugs were given during the operation — which happened for 95.4% of patients — the PONV rate was 16.9%, compared to 39.2% in the small group who received none, confirming that intraoperative prophylaxis makes a real and significant difference.

The Gap Between Policy and Practice — and What Needs to Change

Dubai Hospital’s policy calls for all patients undergoing general anesthesia 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 — meaning that roughly 1 in 4 patients did not get 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 judgment and standardized care. The authors argue that closing this adherence gap — through ongoing staff education, regular clinical audits, and updated guidance for managing diabetic patients — could push PONV rates meaningfully lower. They also acknowledge the study’s limitations: its retrospective, single-centre design means results may not translate directly to hospitals with different protocols, and mild or short-lived nausea may have been under-documented in nursing records.

Read the published article here: https://bit.ly/4oGd8Ky

JOURNAL

The Open Anesthesia Journal

DOI: 10.2174/0125896458493559260522051239

The research was led by corresponding author Dr. Jameelulla Aleemulla Shariff | jashariff@dubaihealth.ae | Department of Anaesthesia, Dubai Hospital, PO Box 7272, Al Baraha, Dubai, UAE