Background: Outpatient tympanomastoidectomy is common in many medical cente
rs. However, failure of same-day discharge is often the result of postopera
tive nausea and vomiting (PONV). Many times this leads to hospital admissio
n after tympanomastoidectomy, and it is often difficult to predict before s
urgery whether PONV will be an issue that impedes same-day discharge.
Objective: To determine the clinical factors correlated with the incidence
of PONV requiring hospital admission after chronic ear surgery by hypothesi
zing that the complexity of a particular case, as measured using a 10-point
scale, is predictive of surgical time or failure of same-day hospital disc
harge.
Study Design: Retrospective medical chart review of 103 patients having mas
toidectomy with tympanoplasty for chronic otitis media over a 2-year period
.
Methods: We recorded patient age, clinical data, surgical times, types of a
gents used for induction and maintenance of anesthesia, use of prophylactic
antiemetic drugs, types and doses of analgesic agents, and PONV. Univariat
e and multivariate logistic regression analyses were performed to determine
which variables were associated with PONV that required hospital admission
.
Results: One third of patients studied were safely discharged from the hosp
ital the day of surgery, and 92% were discharged within 23 hours. The most
common cause for observation admission to the hospital was PONV. The only v
ariable in multivariate analysis that significantly correlated with PONV ma
ndating hospital admission after tympanomastoid surgery was a history of mo
tion sickness or PONV (odds ratio, 5.21; P=.02). Although severity of disea
se did not correlate with length of hospital stay, it directly correlated w
ith length of surgery.
Conclusions: A history of PONV or motion sickness is predictive of PONV and
length of hospital stay. Routine planning for a 23-hour overnight observat
ion stay seems warranted for all patients undergoing tympanomastoidectomy,
despite severity of disease.