Incidence and Risk Factors of Postoperative Nausea and Vomiting among Patients Undergoing Surgery under General Anesthesia

Background: Postoperative nausea and vomiting (PONV) constitutes a prevalent and debilitating complication of general anesthesia, imposing significant physiological burden and health system costs, particularly in resource-constrained clinical environments. Objective: The present investigation determined the incidence of PONV and characterized its associated patient-level, surgical, and anesthetic risk factors among adults undergoing elective surgery under general anesthesia. Methods: A prospective observational study was conducted at the 250-bed General Hospital, Naogaon, Bangladesh, between July 2024 and June 2025. A consecutive sample of 104 adult patients (aged ≥18 years) undergoing elective surgery under general anesthesia was enrolled. Data on 22 variables encompassing demographics, ASA physical status, anesthetic agents, opioid exposure, antiemetic prophylaxis, and postoperative outcomes were recorded. PONV was assessed at 0–24 hours and 24–48 hours postoperatively using a structured severity scoring instrument. Statistical analyses comprised chi-squared tests, Mann–Whitney U tests, and descriptive statistics performed with SPSS version 26.0 (IBM Corp., Armonk, NY, USA), with significance set at p < 0.05. Results: The overall PONV incidence was 15.4% (n=16/104). PONV occurred predominantly within the first 24 hours postoperatively (15.4%), with only two patients (1.9%) experiencing symptoms between 24 and 48 hours. The mean patient age was 44.49 ± 16.10 years, with a mean BMI of 26.16 ± 4.44 kg/m². Among patients with PONV, the mean severity score was 1.44 ± 1.36; severe PONV (score 3) was documented in 6 patients (37.5% of the PONV cohort). Importantly, age group distribution demonstrated a statistically significant association with PONV (χ² = 16.64, p = 0.001), with the 18–30-year age group exhibiting the highest incidence (36.0%). The mean hospital length of stay was 2.99 ± 1.23 days for PONV patients versus 2.90 ± 1.12 days for non-PONV patients (p = 0.752). Volatile anesthetic use, nitrous oxide administration, intraoperative and postoperative opioid exposure, sex, ASA class, and surgical specialty did not demonstrate statistically significant associations with PONV in this cohort. Rescue antiemetic therapy was required by all 16 PONV patients (100%). Conclusion: PONV affected approximately one in six patients undergoing general anesthesia at this district-level facility. Younger patient age emerged as the sole statistically significant predictor, underscoring the necessity for individualized prophylactic protocols in low-resource surgical settings.