Variation in practice patterns of anesthesiologists in California for prophylaxis of postoperative nausea and vomiting

Study Objective: To assess the responses to a survey asking anesthesiologis ts to report their clinical practice Patterns for Postoperative nausea and vomiting (PONV) prophylaxis. These practice patterns data may be useful for understanding how to optimize the decision to provide PONV prophylaxis. Design: A written questionnaire with three detailed clinical scenarios with differing levels of a priori risk of PONV (a low-risk patient, a medium-ri sk patient, and a high-risk patient) was mailed to 454 anesthesiologists. S etting: Survey was completed by anesthesiologists (n = 240) in 3 university and 3 community practices in California. Measurements: Type and number of pharmacological and nonpharmacological int erventions for PONV prophylaxis were recorded. To assess the variability in the responses (by the a priori risk of patient), we counted the number of different regimens that would be necessary to account for 80 % of the respo nses. Main Results: For the 240 respondents, we found that 1, 9, and 11 different pharmacological prophylaxis regimens were required to account for 80 % of the variability in practice patterns for the low-, medium-, and high-risk p atients, respectively. For the low-risk patient, 19% of practitioners would use pharmacological Prophylaxis, and 37% would use nonpharmacological prop hylaxis. For the medium-risk patient, 61 % would use nonpharmacological pro phylaxis and 67 % of practitioners would use multidrug prophylaxis: 45 % of patients would receive a 5HT(3) antagonist, 35 % would receive metoclopram ide, and 16 % would receive droperidol. For the high-risk patient, 94 % of practitioners would administer a 5HT3 antagonist, whereas 84 % would use mu lti-drug prophylaxis. Conclusions: We found a wide range of PONV prophylaxis management patterns. This variation in clinical practice may reflect uncertainty about the effi cacy of available interventions, or differences in practitioners' clinical judgment and beliefs about how to treat PONV. Some therapies with proven be nefit for PONV may be underused. Our results may be useful for designing st udies aimed at determining the impact on PONV rates when physicians develop and implement guidelines for PONV prophylaxis. (C) 2001 by Elsevier Scienc e Inc.