Examining Scopolamine Use for the Prevention of Postdischarge Nausea and/or Vomiting: A Secondary Analysis James Masiongale, CRNA, DNP Jane Garvin, PhD, APRN, FNP-BC Marguerite Murphy, DNP, RN Stephen W. Looney, Ph.D.
Georgia Regents University College of Nursing 1
Definitions
1-3
Lack of a common definition
Postoperative Nausea &/or Vomiting (PONV)
• Recovery to discharge (PACU) • Recovery through 24 hrs • Recovery through 48 hrs
Post discharge nausea &/or vomiting (PDNV)
• Time of discharge through 7 days • 24 hrs through 7 days • 48 hrs through7 days
References: 1ASPAN, 2006; 2Cohen et al.,1984; 3Kovac, 1999
2
Postdischarge Nausea &/or Vomiting (PDNV) Incidence/Negative Consequences 50% for general anesthesia4-6
Decreased quality of life7
Patient dissatisfaction
Complications8
Decreased ADL
Increased cost
References: 4Gan &Reeves, 2002; 5Odom-Forren, et al., 2006; 6Odom-Forren, et al., 2013; 7Macario et al.; 8Gold et al., 1989
3
Guidelines for Prevention/Management of PONV Apfel PONV risks score
Expected PONV 90%
Risk Factor
Points
Female Gender
1
Non-smoker
1
History PONV &/or motion sickness
1
Opioids in PACU
1
Sum
0…4
References: 9Apfel et al., 1999
80% E 70% I e x n 60% p c e 50% i c 40% d t 30% e e 20% n d c 10% 0%
4 3 2 1 0
Number of Risks References: 1ASPAN, 2006; 9Apfel et al., 1999
4
Guidelines for Prevention/Management of PDNV Apfel PDNV risks score Risk Factor
Points
Female Gender
1
Age < 50 years
1
History PONV
1
Opioids in PACU
1
PONV in PACU Sum
1 0…5
Expected PDNV 90% 80% E I e 70% x n p 60% c e 50% i c 40% d t 30% e e 20% n d c 10% 0%
5 4
3 2 1 0
Number of Risks References: 10Apfel et al., 2012
5
Recommended Treatment PONV A4 n t i 3 e m e 2 t i c 1 s 0
9
PDNV 10
– Use PDNV risk score to identify those at risk – Consider long acting antiemetic such as TDS for those at risk 4 3 2 0
1 Risk References: 9Apfel et al., 1999 10Apfel et al., 2012
6
Study Aims 1
2
3
4
• Describe the sample
• Examine the use of TDS in an ambulatory setting • Examine the use of TDS based on a PONV risk score ≥ 3 and PDNV score ≥ 1
• Describe the effectiveness of TDS on PDNV and PONV
7
Design Secondary data analysis
• Multicenter, prospective, observational cohort
Adult, ambulatory • Approval from GRU surgical patients IRB undergoing general anesthesia in US. • N = 2170
Limited my study data based on ability to calculate risk scores
• N = 2098
8
Results Demographics 60 50 49.7 40 30 28.3 20
90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
84% 65%
63%
30%
25%
20%
10 0 Age (years) SD ± 15.4
BMI
SD ± 6.9
9
Demographics Type Surgical Procedure
TDS use by Procedure N = 78
N = 2098
Breast 10%
Knee 11%
General 20%
Breast, 31% GYN 11%
General, 14%
GYN, 30%
7 Other Surgeries 48% All others, 25%
10
Overall TDS Use TDS Anesthesia, 3% N = 71
TDS PACU, 1% N=7
No TDS, 96% N =2020
11
Antiemetic Use Antiemetic in PACU
Antiemetic in Anesthesia
0%
20%
40%
Antiemetic in Anesthesia TDS in PACU (N = 7) 100% TDS in Anesthesia (N = 71) 96% No TDS (N = 2020) 85%
60%
80%
100%
Antiemetic in PACU 100% 34% 15% 12
Qualified for TDS use with PONV RS ≥ 3 TDS use 6% 6 6% N =78
PONV RS ≤2 46%
PONV RS ≥3 54% N = 1133
N =965
No TDS 94%
N = 1055
N = 2098
N = 1133
13
Qualified for TDS use with PDNV RS ≥ 1 PDNV PDNV RS < 1 RS 0 8% 8%
TDS use
4% N = 78
N = 168
PDNV RS ≥ 1 92% N = 1930
N = 2098
No TDS PDNV RS ≥ 1 96% N = 1852
N = 1930
14
Participants with PDNV RS ≥3
PDNV RS ≥ 3 44% N = 923
PDNV RS ≤ 2 56% N = 1175
15
TDS Use Limited to High Risk Scores PDNV RS