Antiemetic prophylaxis does not improve outcomes after outpatient surgery when compared to symptomatic treatment

Background: Although prophylactic administration of antiemetics reduces the incidence of postoperative nausea, vomiting, or both (PONV), there is litt le evidence to suggest this improves patient outcomes. The authors hypothes ized that early symptomatic treatment of PONV will result in outcomes, incl uding time to discharge, unanticipated admission, patient satisfaction, and time to return to normal daily activities, that are similar to those achie ved with routine prophylaxis. Methods: Men and women (n = 575) scheduled for outpatient surgery during ge neral anesthesia were randomized to receive either 4 mg intravenous ondanse tron or placebo before operation and either 1 mg intravenous ondansetron or placebo if postoperative symptomatic treatment of PONV was necessary. Pati ents were stratified into subgroups by risk factors for PONV. Results: No differences occurred in the time to discharge, rate of unantici pated admission, or time to return to normal activity between the prophylax is and treatment groups. The reported level of satisfaction with control of PONV was 93% in the treatment arm and 97% in the prophylaxis arm, which fa ll within the limits defined a priori as clinically equivalent. Female pati ents with a history of motion sickness or PONV who were undergoing highly e metogenic procedures had a higher reported level of satisfaction with proph ylaxis than with treatment (100% us. 90%, P = 0.043); however, the level of satisfaction with the overall outpatient surgical experience was not diffe rent. Conclusion: Although PONV is unpleasant, the data indicate little differenc e in outcomes when routine prophylactic medications are administered versus simply treating PONV should symptoms occur.