Real-World Impact on Postoperative Vomiting by Changing Anesthesia Regimens in Children Undergoing Strabismus Surgery: An Interrupted Time Series Analysis

Abstract

Background: Preventive measures for postoperative vomiting (POV) in pediatric strabismus surgery are essential. Previous experimental studies have shown the independent antiemetic effects of propofol-based total intravenous anesthesia (TIVA), dexamethasone (DEX), and ondansetron (OND). However, the real-world outcomes of POV following the combined use of DEX and OND with propofol/opioid TIVA remain unknown.

Aims: To evaluate the longitudinal incidence of POV across three phases of different anesthesia regimens.

Methods: This retrospective observational study was conducted at a single tertiary-care children's hospital in Japan, including children aged < 18 years who underwent strabismus surgery and had no major comorbidities. The primary outcome was either POV or the use of antiemetics within 24 h or by discharge. Changes in the levels and time-trend slopes of POV were evaluated using interrupted time series analysis among three phases: (1) sevoflurane with pentazocine, (2) propofol/opioid TIVA with DEX, and (3) propofol/opioid TIVA with DEX and OND.

Results: Of the 2378 children, the POV incidence in Phases 1, 2, and 3 was 109/471 (23.1%), 87/1260 (6.9%), and 28/647 (4.3%), respectively (p < 0.001). A significant level change in POV occurrence was observed from Phase 1 to Phase 2, while no significant level change was found from Phase 2 to Phase 3. The time-trend changes in POV occurrence showed no significant difference during Phases 2 and 3.

Conclusions: Real-world departmental-level data showed a decrease in POV occurrence after transitioning from sevoflurane-based anesthesia with pentazocine to propofol/opioid TIVA with DEX. However, no significant decrease in POV occurrence was found by adding OND to propofol/opioid TIVA with DEX. Further studies are needed to improve the generalizability of evaluating the real-world antiemetic effect of combining antiemetic medications on propofol/opioid TIVA.

Keywords: child; general anesthesia; interrupted time series analysis; postoperative nausea and vomiting; strabismus.