Treatment-Requiring Postoperative Nausea and Vomiting in Ambulatory Oncology Surgery: Four-Year Trends in Antiemetic Utilization

Background/Objectives: Postoperative nausea and vomiting (PONV) remains an important complication after ambulatory cancer surgery. This study evaluated four-year trends in treatment-requiring post-anesthesia care unit (PACU) PONV, prophylactic aprepitant utilization, and rescue amisulpride administration. Methods: A retrospective descriptive analysis of monthly perioperative quality-improvement data was conducted from January 2022 through December 2025. The primary outcome was postoperative nausea and/or vomiting requiring antiemetic treatment in the PACU. Because the source data were aggregated, nausea and vomiting could not be analyzed separately, and patient-level risk adjustment was not possible. Results: A total of 15,467 ambulatory cancer surgeries were analyzed. Treatment-requiring PACU PONV occurred in 2041 cases (13.2%) overall and was 20.3% in 2022, 13.3% in 2023, 9.1% in 2024, and 9.9% in 2025. Aprepitant was administered in 6927 cases (44.8%); among aprepitant recipients, 1331 (19.2%) required PACU treatment for PONV. Among 8540 cases without aprepitant, 710 (8.3%) required PACU treatment for PONV. This unadjusted difference should not be interpreted as an estimate of aprepitant effectiveness because treatment allocation was influenced by baseline risk. Rescue amisulpride was administered in 748 cases (4.8%). Conclusions: Treatment-requiring PACU PONV declined over the four-year observation period. Concurrent changes in antiemetic utilization are descriptive and cannot establish that any specific medication or practice change caused the observed decline.