Association between intraoperative pulse pressure variation and early postoperative nausea and vomiting in major abdominal surgery: A retrospective study

BACKGROUND: Postoperative nausea and vomiting (PONV) remains a common early complication within 24-h period after general anesthesia. While intravenous fluid therapy may reduce PONV by mitigating intestinal hypoperfusion, its efficacy lacks quantifiable indicators. This study investigates the association between intraoperative pulse pressure variation (PPV), a fluid responsiveness parameter, and early PONV in patients undergoing major abdominal surgery. METHODS: This retrospective study analyzed data from 229 adult patients who underwent major abdominal surgery at a tertiary care hospital. PPV values, obtained via radial arterial catheters, were recorded intraoperatively. Patients with conditions that could bias PPV accuracy or PONV diagnosis were excluded. PONV within 24 h post-surgery was assessed. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for PONV. RESULTS: Among 229 patients, 59 (25.8%) developed early PONV within 24-h after surgery. Patients with PONV had significantly higher Apfel scores (2.9 ± 0.8 vs. 2.5 ± 0.9; p = 0.003) and a higher proportion of laparoscopic surgeries (49.2% vs. 32.4%; p = 0.002). Episodes of PPV >13% were more common in the PONV group (81.4% vs. 52.9%; p < 0.001). Multivariate analysis identified Apfel score (OR 1.566, 95% CI 1.094-2.241; p = 0.014) and episodes of PPV >13% (OR 4.386, 95% CI 2.079-9.346; p < 0.001) as independent risk factors for PONV. CONCLUSION: Intraoperative PPV >13% is independently associated with early PONV in patients undergoing major abdominal surgery. Monitoring and managing PPV during surgery may enhance PONV prevention strategies. TRIAL REGISTRATION: This retrospective study was approved by the National Taiwan University Hospital Ethics Committee (Approval No.: 201612070RINC). The approval date was Dec 07, 2016.