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Post-operative vomiting and enhanced recovery after congenital cardiac surgery

Published online by Cambridge University Press:  24 March 2022

M. Fernanda Parra ,
Morgan L. Brown ,
Steven J. Staffa ,
Meena Nathan  and
Nathalie Roy Open the ORCID record for Nathalie Roy [Opens in a new window]
M. Fernanda Parra
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, MA, Boston, USA Harvard Medical School, Boston, MA, USA
Morgan L. Brown
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, MA, Boston, USA Harvard Medical School, Boston, MA, USA
Steven J. Staffa
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, MA, Boston, USA
Meena Nathan
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, MA, Boston, USA Harvard Medical School, Boston, MA, USA
Nathalie Roy*
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, MA, Boston, USA Harvard Medical School, Boston, MA, USA
*
Author for correspondence: Nathalie Roy, MD, Department of Cardiac Surgery, 300 Longwood Avenue, Bader 292, Boston, MA 02115, USA. Tel: +1. 617 919 6364; Fax: +1 617 730 0214. Email: [email protected]
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Abstract

Background:

Post-operative nausea and vomiting is frequent after congenital cardiac surgery.

Aims:

We sought to determine factors associated to severe post-operative vomiting after congenital cardiac surgery and the effect on post-operative outcomes.

Methods:

Patients > 30 days of age who underwent elective cardiac surgical repair as part of an enhanced recovery after congenital cardiac surgery programme were retrospectively reviewed. Patient characteristics and perioperative factors were compared by univariate analysis for patients with severe post-operative vomiting, defined as three events or more, and for patients with no-or-mild post-operative vomiting. All variables with a p-value < 0.1 were included in a multivariable model, and major post-operative outcomes were compared using regression analysis.

Results:

From 1 October, 2018 to 30 September, 2019, 430 consecutive patients were included. The median age was 4.8 years (interquartile range 1.2–12.6). Twenty-one per cent of patients (91/430) experienced severe post-operative vomiting. Total intraoperative opioids > 5.0 mg/kg of oral morphine equivalent (adjusted odds ratio 1.72) and post-operative inotropes infusion(s) (adjusted odds ratio 1.64) were identified as independent predictors of severe post-operative vomiting after surgery. Patients suffering from severe post-operative vomiting had increased pulmonary complications (adjusted odds ratio 5.18) and longer post-operative hospitalisation (adjusted coefficient, 0.89).

Conclusions:

Greater cumulative intraoperative opioids are associated with severe post-operative vomiting after congenital cardiac surgery. Multimodal pain strategies targeting the reduction of intraoperative opioids should be considered during congenital cardiac surgery to enhance recovery after surgery.

Keywords

Enhanced recovery after surgerypost-operative nausea and vomitingopioidsanesthesiacongenital cardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 2 , February 2023 , pp. 260 - 265
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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