J Perianesth Nurs. 2026 May 16:S1089-9472(26)00080-8. doi: 10.1016/j.jopan.2026.03.018. Online ahead of print.
ABSTRACT
PURPOSE: Postoperative nausea and vomiting (PONV) is a common occurrence that leads to patient discomfort and prolonged length of stay. The average rate of PONV is approximately 30% in the general population and can be as high as 70% to 80% in those at high risk. Enhanced recovery after surgery (ERAS) protocols have been created from analysis of current evidence-based research aimed to decrease postoperative complications and improve patient outcomes following surgical interventions.
DESIGN: This retrospective pre-experimental cohort study used convenience sampling of 1,200 past surgical patients to determine the trend of PONV rates in females who underwent laparoscopic gynecological surgery from 2018 to 2024, and to examine whether there was a difference in PONV rates between those who received general anesthesia utilizing ERAS protocols and those who did not during the designated time period.
METHODS: Compliance with antiemetic ERAS protocols was recorded and defined by the administration of three or more antiemetics, and noncompliance was defined as fewer than three. The primary outcome, the presence of PONV, was assessed by the administration of rescue antiemetics in the postanesthesia care unit (PACU). Additional outcomes included PACU length of stay and provider compliance with the ERAS protocols.
FINDINGS: The findings reflect those who received a general anesthetic before the introduction of the ERAS protocol through its early and most current use. During this time period, 1,200 patients underwent laparoscopic gynecologic surgery with general anesthesia. The study divided participants into pre-ERAS (2018 to 2019), early-ERAS (2020 to 2022), and current-ERAS (2023 to 2024) groups. The result of this study found a statistically significant decrease in ERAS compliance (P = .004), with a concurrent increase in PONV rates (P < .001). In patients who reported PONV, PACU length of stay increased from a mean of 92.75 (44.8) minutes in 2018 to 2019 to 130.7 (47.8) minutes in 2023 to 2024 (P = .001). Our study discovered that there was an overall decrease in compliance rates with antiemetic prophylactic administration throughout all phases of the perioperative period.
CONCLUSIONS: PONV is a key postoperative issue affecting patient comfort, recovery, and health care resources. Our findings emphasize the importance of comprehensive ERAS adherence beyond pharmacologic prophylaxis and call for further research to refine protocols based on patient outcomes, risk factors, and evolving pharmacology.
PMID:42143626 | DOI:10.1016/j.jopan.2026.03.018
