Postoperative nausea and vomiting after facelift surgery despite routine dual antiemetic prophylaxis

Abstract Background Postoperative nausea and vomiting (PONV) is a common complication of surgery and anesthesia. We evaluated its incidence, associated factors, and clinical consequences after facelift surgery under routine antiemetic prophylaxis. Methods This retrospective single-center cohort included 220 consecutive patients undergoing elective facelift surgery in 2025. General anesthesia was maintained with sevoflurane; 212 patients (96.36%) received dexamethasone and ondansetron. PONV was defined as any nausea (visual analogue scale ≥ 1) and/or vomiting within 24 hours. Patient and procedural variables were evaluated using multivariable logistic regression. Results PONV occurred in 137 patients (62.27%; 95% confidence interval [CI]: 55.71–68.42%); 108 (49.09%) vomited and 127 (57.73%) required rescue antiemetics. Concurrent blepharoplasty (odds ratio [OR]: 5.674; 95% CI: 2.704–11.905) and operative duration (OR per minute: 1.013; 95% CI: 1.009–1.018) were independently associated with PONV. The Apfel score was not significantly associated with PONV (p = 0.262). Hospital stay was longer in patients with PONV (48.31 ± 6.79 versus 39.19 ± 6.80 hours; p < 0.001), and fewer were very satisfied (2.19% versus 81.93%; p < 0.001). Conclusions PONV was frequent after facelift surgery despite routine dual prophylaxis. Concurrent blepharoplasty and longer operative duration were independently associated with PONV. Restricted variation in baseline risk factors limits interpretation of the nonsignificant Apfel association. Prospective studies should assess preventive strategies for prolonged and combined procedures.