Incidence and Predictors of Postoperative Nausea and Vomiting (PONV) after General Anesthesia in Patients Undergoing Laparoscopic Cholecystectomy

Abstract

Background: Postoperative nausea and vomiting (PONV) remain a common and distressing complication following general anesthesia, particularly in laparoscopic procedures where emetogenic stimuli are pronounced. It adversely affects patient recovery, satisfaction, and healthcare costs. This study aimed to determine the incidence and predictors of PONV in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Methods: This prospective observational study included 195 patients undergoing elective laparoscopic cholecystectomy under general anesthesia at DHQ hospital, Dera Ismail Khan, Pakistan. Data on demographic, clinical, anesthetic, and surgical variables were collected. The primary outcome was the occurrence of PONV within 24 hours postoperatively. Associations were analyzed using chi-square tests, and independent predictors were identified through multivariate binary logistic regression.

Results: The incidence of PONV was 56.9% (111/195) patients. In multivariate analysis, intraoperative opioid use was the strongest independent predictor (AOR = 19.79, p = 0.017). Induction agent selection was also significantly associated with PONV (AOR = 3.08, p = 0.016). Additionally, longer duration of surgery (χ² = 12.87, p = 0.005) and pneumoperitoneum (χ² = 12.35, p = 0.002) showed significant associations. The model demonstrated excellent performance (Nagelkerke R²=0.809, classification accuracy=90.3%).

Conclusion: PONV remains highly prevalent following laparoscopic cholecystectomy. Modifiable anesthetic factors, particularly opioid administration and induction agent choice, play a critical role. Strategies such as opioid-sparing multimodal analgesia and propofol-based anesthesia may help reduce PONV incidence and improve postoperative outcomes.