Sustained hypotension during shoulder arthroscopy is associated with postoperative nausea and vomiting

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common and distressing complication following shoulder arthroscopy. Although hypotension is known to trigger nausea, the specific association between sustained intraoperative hypotension (SIH) during shoulder arthroscopic surgery and PONV has not been well characterized. This retrospective study aimed to investigate whether SIH is independently associated with PONV. METHODS: We retrospectively analyzed data from 306 patients who underwent shoulder arthroscopy between March 2018 and January 2024. SIH was defined as a ≥ 20% decrease in mean arterial pressure (MAP) from baseline persisting for at least 60 minutes during the controlled hypotension phase. Univariate logistic regression analysis and multivariate exact logistic regression analysis were performed to identify factors associated with the occurrence of PONV. PONV severity was compared between the SIH and non-SIH groups using the chi-square test. RESULTS: PONV occurred in 96 patients (31.37%). Univariate logistic regression analysis revealed that females, smoking, history of motion sickness and/or PONV, and SIH were related to the occurrence of PONV (all p < 0.05). Multivariate logistic regression analysis revealed that females (adjusted OR: 3.966, 95% CI: 2.149-7.317, p < 0.001), smoking (adjusted OR: 0.232, 95% CI: 0.107-0.501, p < 0.001), history of motion sickness and/or PONV (adjusted OR: 32.393, 95% CI: 3.801-276.051, p = 0.001), and SIH (adjusted OR: 2.198, 95% CI: 1.289-3.749, p = 0.004) were independently associated with the occurrence of PONV. Additionally, patients with SIH exhibited significantly higher severity grades for both nausea (p = 0.002) and vomiting (p = 0.007). CONCLUSION: SIH due to controlled hypotension during shoulder arthroscopic surgery was independently associated with PONV. SIH may serve as a clinically relevant predictor for PONV.