Abstract
Postoperative nausea and vomiting (PONV) remain common complications following endovascular intervention. The unique risks for patients undergoing endovascular therapy under local or monitored anaesthesia care (MAC) remain poorly characterized. To investigate the risk factors for PONV after endovascular interventional therapy. A total of 319 patients were included in this case–control study. Initially, we compared the baseline clinical and endovascular intervention characteristics of 25 patients who experienced PONV with those of 294 control patients. A multivariate logistic regression model was subsequently employed. Sex, allergic history, intervention type, and operation duration differed significantly between two groups. According to the multivariate logistic regression model, sex (female) (OR = 2.66; 95% CI: 1.04–6.84; p = 0.042), a history of allergies (OR = 6.56; 95% CI: 2.32–18.56; p < 0.001), an eGFR < 60 ml/min/1.73 m² (OR = 5.89; 95% CI: 1.99–17.49; p = 0.001), embolization (OR = 3.29; 95% CI: 1.20–8.98; p = 0.020), and an iodine contrast agent concentration > 400 ml (OR = 18.54; 95% CI: 2.38–144.28; p = 0.005) were significant risk factors for PONV. Sex (female), a history of allergies, renal insufficiency, embolization and the use of high–dose iodine contrast agents were significant risk factors for PONV after endovascular interventional therapy.
Trial registration: The trial was registered online on 11th November 2024 in the Chinese Clinical Trial Registry (ChiCTR2400092672).
Supplementary Information
The online version contains supplementary material available at 10.1038/s41598-025-18866-2.
Keywords: Endovascular interventional therapy, Postoperative nausea and vomiting (PONV), Risk factors, Iodine contrast agent
Subject terms: Peripheral vascular disease, Digestive signs and symptoms, Vomiting
Introduction
Endovascular interventional therapy is preferred because of its minimally invasive nature, rapid recovery, and short hospital stay. These properties make it the preferred option for elderly or severely ill patients who cannot tolerate traditional surgery1,2. However, postoperative nausea and vomiting (PONV) remain common complications, with incidence rates ranging from 20 to 30% in general populations and reaching 70–80% among high–risk groups3. In addition to compromising patient satisfaction4,5, PONV occurrence prolongs postanaesthesia care unit (PACU) stays6, increases unplanned hospitalizations7, and increases healthcare costs8.
Understanding the clinical profiles of patients who experience vomiting after interventional procedures is critical for developing predictive nursing strategies9, optimizing medical decision–making, and improving perioperative safety. Multivariate analyses of large cohorts have established key PONV predictors in adults, including female sex, prior PONV episodes and/or susceptibility to motion–induced vertigo, absence of tobacco use, and young age10–13. Additionally, the use of iodine contrast agents during interventional procedures emerges as a modifiable risk factor during radiological procedures14.
While existing PONV research focuses primarily on general anaesthesia, the unique emetic risks for patients undergoing endovascular therapy under local or monitored anaesthesia care (MAC) remain poorly characterized. This proposed case–control study aims to analyse adult patients who have undergone interventional procedures over the past four years to identify novel PONV risk factors in MAC/local anaesthesia settings. By generating evidence–based insights, this research aims to develop targeted nursing interventions that mitigate PONV, enhance recovery experiences, and establish best practices for this expanding patient population.
Methods
Study design
The study population comprised patients who underwent endovascular interventional therapy at the Vascular Surgery Department of Southwest Hospital from 2020.01.01 to 2023.12.31. Data were collected from anthropometric measurements, laboratory tests, surgical records, and nursing records. Anthropometric measurements included height and weight. Laboratory tests included preoperative creatinine levels and the estimated glomerular filtration rate (eGFR). Surgical records included the type and amount of contrast agent used, the amount of local anesthetic administered, the duration of the surgery, and the endovascular intervention characteristics (arterial/venous, anatomical region, intervention types, endovascular devices, and approach). Nursing records documented the allergy history, the occurrence of PONV, and the time of PONV onset.
New–onset nausea and vomiting within 24 h after the interventional procedure were defined as cases of PONV. A total of 25 cases and 294 controls were identified.
The Ethics Committee of Southwest Hospital approved this study. Furthermore, for this retrospective study, the Ethics Committee of Southwest Hospital agreed to waive the requirement for informed consent. All methods were performed in accordance with the relevant guidelines and regulations.
Inclusion criteria
(1) Patients who underwent interventional therapy in the vascular surgery department between January 1, 2020, and December 31, 2023. (2) Age > 18 years. (3) Received local anaesthesia or monitored anaesthesia care.
Exclusion criteria
(1) Preoperative presence of acute/chronic gastrointestinal diseases or nausea, vomiting, acid reflux, and belching caused by any reason. (2) General anaesthesia or having undergone general anaesthesia within the past month. (3) Having undergone chemotherapy within the past month.
Statistics
The Shapiro–Wilk test (for n ≤ 50) or the Kolmogorov–Smirnov test (for n > 50), along with normal Q–Q plots, was employed to assess the normality of the continuous variables (Supplementary Table 1, Supplementary Fig. 1). Continuous variables that did not display a normal distribution are presented as medians with interquartile ranges (IQRs), and the Mann–Whitney U test was used to compare the significance of differences between two groups. Continuous variables with a normal distribution are presented as the means ± standard errors of the means (SEMs). The Levene test was used to assess the homogeneity of variance. For continuous variables that were normally distributed, the t–test was applied.
Categorical variables are expressed as frequencies and percentages, and the chi–square test was used for statistical comparisons. When the expected value of more than 25% of the cells was less than 5, Freeman–Halton test was adopted. Post–hoc pairwise comparisons of specific intervention types were performed using Fisher’s exact tests, with statistical significance defined by a Bonferroni–corrected alpha threshold of 0.007 (0.05/7 comparisons).
A multivariate logistic regression model was used to investigate the relationships between various factors and PONV after the intervention. For each unit-scale increment in each variable, the odds ratio (OR) with a 95% confidence interval (95% CI) for nausea/vomiting was calculated.
IBM SPSS Statistics 25.0 (IBM Co., New York, USA) was used for the statistical analyses. A p–value < 0.05 was considered to indicate statistical significance.
Results
Baseline characteristics of the participants
A total of 1668 patients underwent endovascular interventional procedures for nonmalignant conditions from 1/1/2020 to 12/31/2023 in our department. Among these, 319 patients were included in the analysis because their complete and eligible data met the inclusion criteria. Subsequently, 25 of these patients were confirmed to have experienced nausea or vomiting within 24 h after surgery. Specifically, 17 patients developed vomiting, while 8 patients reported nausea alone. No preventive antagonist for nausea or vomiting was administered.
In terms of demographic characteristics, no statistically significant difference in age was observed between the two groups (t = 0.177; p = 0.860). With respect to the sex composition, the case group consisted of 40.00% (n = 10) males and 60.00% (n = 15) females, whereas the control group included 61.22% (n = 180) males and 38.78% (n = 114) females. A significant difference in sex distribution was observed between the two groups (χ² = 4.390; p = 0.038), with the case group encompassing a significantly higher proportion of females than the control group (Table 1).
Table 1.
Baseline characteristics of the case and control groups.
| Control | Case | Statistic | p value | |
|---|---|---|---|---|
| n | 294 |
25 (Vomiting = 17, Nausea = 8) |
– | – |
|
Age (years) (mean ± SEM, 95%CI) |
57.14 ± 0.9 (95%CI:55.36–58.92) |
56.56 ± 3.82 (95%CI:48.68–64.44) |
0.177 | 0.860 |
|
Sex (female/male) (n, %) |
114/180 (38.78%/61.22%) |
15/10 (60.00%/40.00%) |
4.390 | 0.038* |
|
Height (cm) (mean ± SEM, 95%CI) |
162.11 ± 0.46 (95%CI:161.21–163.01) |
160.6 ± 1.43 (95%CI:157.66–163.54) |
0.933 | 0.352 |
|
Weight (kg) (mean ± SEM, 95%CI) |
64.01 ± 0.73 (95%CI:62.57–65.45) |
59.41 ± 2.04 (95%CI:55.21–63.61) |
1.784 | 0.075 |
|
BMI (kg/m2) (mean ± SEM, 95%CI) |
24.27 ± 0.22 (95%CI:23.83–24.71) |
23.00 ± 0.67 (95%CI:21.62–24.37) |
1.609 | 0.109 |
|
Allergic history (positive/negative) (n, %) |
22/272 (7.48%/92.52%) |
8/17 (32.00%/68.00%) |
16.255 | < 0.001* |
|
Creatinine (umol/l) (median, IQR, 95%CI) |
70.20, 23.00 (95%CI:57.40–85.10) |
69.50, 44.00 (95%CI:67.19–73.60) |
– | 0.808 |
|
eGFR (ml/min/l) (mean ± SEM, 95%CI) |
92.5 ± 1.52 (95%CI:89.51–95.48) |
88.54 ± 7.88 (95%CI:72.28–104.79) |
0.494 | 0.626 |
Continuous variables such as age, height, weight, BMI, and eGFR were expressed as mean ± SEM. Student‘s t test was used to compare the statistical differences between the two groups. Creatinine didn’t follow a normal distribution; therefore, the median and IQR were presented, and the Mann–Whitney U test was used for statistical analysis. Categorical variables such as sex and allergy history were expressed as the number of samples, and the chi–square test was used to compare the statistical differences between the two groups. p < 0.05 indicates statistical significance.
Approximately half of the participants in both the case group (48.00%, n = 12) and the control group (47.62%, n = 140) had a BMI within the healthy range (18.5–24 kg/m²). Additionally, approximately half of the participants in the case group (40.00%, n = 10) and the control group (48.64%, n = 143) were classified as overweight (> 24 kg/m²) (Fig. 1). However, a significant difference in the BMI was not observed between the two groups (t = 1.609; p = 0.109) (Table 1).
Fig. 1.
Scatter plot of BMI for two groups.
In terms of the allergic history, a significant proportion of participants in both the case group (32.00%, n = 8) and the control group (7.48%, n = 22) reported allergies. The distribution of the allergic history differed significantly between the two groups (χ² = 16.255, p < 0.001). A total of 13 allergens were reported by participants in both groups, with penicillin, an iodine contrast agent, and sulfonamide as the most common allergens identified (Table 2).
Table 2.
Allergens.
| Allergens | Total (n) | Control (n) | Case (n) |
|---|---|---|---|
| Penicillin | 9 | 8 | 1# |
| Iodine contrast agent | 6 | 6 | 0 |
| Sulfonamide | 5 | 2 | 3 |
| Cephalosporin | 4 | 3 | 1# |
| Seafood | 3 | 3 | 0 |
| Human blood albumin | 1 | 0 | 1 |
| Levofloxacin | 1 | 0 | 1 |
| Mango | 1 | 1 | 0 |
| Pain killer | 1 | 1 | 0 |
| Iodophor | 1 | 1 | 0 |
| Radix astragali | 1 | 0 | 1 |
| Tetracycline | 1 | 1 | 0 |
| Unidentified allergen | 1 | 0 | 1 |
Two participants were allergic to penicillin and cephalosporin, and one of them vomited after surgery. One participant was allergic to penicillin and iodophor, who did not nausea and vomiting after surgery.
#This participant is allergic to both penicillin and cephalosporin.
Regarding renal function, a portion of participants in both the case group (32.00%, n = 8) and the control group (28.91%, n = 85) exhibited varying degrees of renal insufficiency preoperatively. However, no statistically significant differences in the serum creatinine concentration or eGFR were observed between the two groups (p = 0.808; t = 0.494; p = 0.626) (Table 1; Fig. 2).
Fig. 2.
Scatter plot of eGFR for two groups.
Characteristics of the endovascular interventional therapy
Regarding the administration of iodine contrast agent, the mean volumes used in the case group and the control group were 188.8 mL (SEM ± 21.21; 95% CI: 145.03–232.57) and 163.28 mL (SEM ± 4.33; 95% CI: 154.76–171.8), respectively. A statistically significant difference in the volume of iodine contrast agent administered was not observed between the two groups (t = − 1.589; p = 0.113) (Fig. 3). In terms of the type of contrast agent adopted, no significant difference was observed between the two groups (χ² = 1.497; p = 0.221).
Fig. 3.
Scatter plot of iodine contrast agent for two groups.
The two groups did not show significant differences in arterial/venous procedures (χ² = 1.448; p = 0.229), anatomical regions (χ² = 8.138; p = 0.151), approach (χ² = 8.160; p = 0.115), or the presence of endovascular devices (χ² = 3.577; p = 0.059) (Table 3). Nevertheless, a significant difference was identified in the overall distribution of intervention types (χ² = 13.246; p = 0.031). Post–hoc pairwise comparisons with the Bonferroni correction (α = 0.007) revealed no significant differences in any individual intervention type (Table 3). Notably, embolization approached statistical significance after correction (p = 0.007) and exhibited an absolute difference in frequency of 20.44% between the two groups. The most common indications for embolization were haemorrhage and hepatic haemangioma (Table 4). The indications for embolization did not differ significantly between the two groups (χ² = 13.246; p = 0.031).
Table 3.
Endovascular intervention characteristics of the case and control groups.
| Control | Case | Statistic | p value | |
|---|---|---|---|---|
|
Iodine contrast agent (ml) (mean ± SEM, 95%CI) |
163.28 ± 4.33 (95%CI:154.76–171.8) |
188.80 ± 21.21 (95%CI:145.03–232.57) |
–1.589 | 0.113 |
|
Iodine contrast agent (ipromide/iodixanol) (n, %) |
105/189 (35.71%/64.29%) |
12/13 (48.00%/52.00%) |
1.497 | 0.221 |
|
Arteries/veins (n, %) |
84/210 (28.57%/71.43%) |
10/15 (40.00%/60.00%) |
1.448 | 0.229 |
|
Anatomical region (n, %) |
8.138 | 0.151 | ||
| Abdomen | 168, 57.14% | 19, 76.00% | ||
| Limbs | 65, 22.11% | 1, 4.00% | ||
| Abdomen, limbs | 46, 15.65% | 3, 12.00% | ||
| Thorax | 12, 4.08% | 2, 8.00% | ||
| Abdomen, thorax | 1, 0.34% | 0, 0% | ||
| Others1 | 2, 0.68% | 0, 0% | ||
| Intervention types | 13.246 | 0.031* | ||
| Embolization | 34, 11.56% | 8, 32.00% | 0.0092 | |
| Revascularization | 164, 55.78% | 11, 44.00% | 0.298 | |
| Endovascular exclusion | 10, 3.40% | 1, 4.00% | 0.599 | |
|
Filter placement / removal |
72, 24.49% | 3, 12.00% | 0.082 | |
| Angiography | 12, 4.08% | 1, 4.00% | 1.000 | |
| Portosystemic shunt | 1, 0.34% | 1, 4.00% | 0.151 | |
| Others3 | 1, 0.34% | 0, 0% | 1.000 | |
|
Endovascular devices (no/yes, n, %) |
142/152 (48.30%/51.70%) |
17/8 (68.00%/32.00%) |
3.577 | 0.059 |
| Approach | 8.160 | 0.115 | ||
| Femoral | 162, 55.10% | 14, 56.00% | ||
| Popliteal | 19, 6.46% | 0, 0% | ||
| Jugular | 114, 38.78% | 3, 12.00% | ||
| Brachial | 3, 1.02% | 0, 0% | ||
| Combined | 67, 22.79% | 7, 28.00% | ||
| Other | 4, 1.36% | 1, 4.00% | ||
|
Lidocaine (ml) (median, IQR, 95%CI) |
5.00, 0 (95%CI:5.00–5.00) |
5.00, 0 (95%CI:5.00–5.00) |
– | 0.710 |
|
Operation duration (min) (median, IQR, 95%CI) |
80.00, 77.00 (95%CI:70.00–85.00) |
120.00, 123.00 (95%CI:80.00–180.00) |
– | 0.011* |
|
Surgery–vomiting time interval (min) (mean ± SEM, 95%CI) |
– |
683.28 ± 194.26 (95%CI:282.34–1084.22) |
– | – |
1. It included 1 case of cervical vascular malformation and 1 case of penile arteriography.
2. Statistically insignificant, 0.009 > 0.007 (Bonferroni corrected alpha).
3. It included 1 case of cardiac pacemaker implantation.
Lidocaine and operation duration didn’t follow normal distribution; therefore, the median and IQR were presented, and the Mann–Whitney U test was used for statistical analysis. Other continuous variables were expressed as mean ± SEM, and Student‘s t test test was used to compare the statistical differences between the two groups. Categorical variables were expressed as the number of samples, and the chi–square test was used to compare the statistical differences between the two groups. When the expected value of more than 25% of the cells was less than 5, Freeman–Halton test was adopted. p < 0.05 indicates statistically significant. Post–hoc pairwise comparisons for specific intervention types were performed using Fisher’s exact tests, with statistical significance defined by a Bonferroni–corrected alpha threshold of 0.007.
Table 4.
The endovascular intervention of embolization Indications.
| Indications | Total (n) | Control (n) | Case (n) | Statistic | p value |
|---|---|---|---|---|---|
| Hemorrhage | 12 | 8 | 4 | 8.066 | 0.160 |
| Arteriovenous fistula | 6 | 4 | 2 | ||
| Hepatic hemangioma | 10 | 9 | 1 | ||
| Pseudoaneurysm | 4 | 4 | 0 | ||
| Internal iliac artery aneurysm | 2 | 2 | 0 | ||
| Vascular malformation | 7 | 7 | 0 | ||
| Splenic artery aneurysm | 1 | 0 | 1 |
In the case group, the mean time to postoperative vomiting was 683.28 min (SEM ± 194.26; 95% CI: 282.34–1084.22) (Table 3).
Logistic regression model
After entering the peripheral circulation, iodine contrast agents are excreted through the urinary system, with their concentration in the body influenced by both the contrast agent and renal function. Therefore, we included the volume and type of contrast agent, as well as the type of angiography and interventional procedure, in our regression analysis. In assessing renal function, the eGFR demonstrated clear advantages over the creatinine concentration; thus, only the eGFR was included in regression analysis. Consequently, the intervention type of embolization was included as an independent variable in regression analysis. Additionally, patient age, sex, BMI, and allergy history were incorporated into the initial regression model (Table 5, full model, Hosmer–Lemeshow test; p = 0.192). The results indicated that only a positive allergy history had a statistically significant effect on PONV following endovascular interventional therapy (OR = 4.74; 95% CI: 1.65–13.62; p = 0.004). The eGFR and contrast agent volume were included in the model as continuous variables, but their impact per unit increase was too small to be clinically meaningful. Consequently, we converted these variables into categorical variables and repeated the logistic regression analysis. Based on backwards stepwise logistic regression, sex, allergy history, eGFR < 60, and an iodine contrast agent concentration > 400 were selected as the optimal model variables for fitting the data (Hosmer–Lemeshow test; p = 0.154).
Table 5.
Logistic regression of the variables potentially affecting vomiting and nausea.
| Full model | Full model (variable transformations) |
Backward elimination model | ||||
|---|---|---|---|---|---|---|
| OR (95%CI) | p | OR (95%CI) | p | OR (95%CI) | p | |
| Age |
1.00 (0.97–1.04) |
0.832 |
1.00 (0.97–1.03) |
0.762 | – | – |
| BMI |
0.95 (0.83–1.09) |
0.453 |
0.95 (0.83–1.10) |
0.485 | – | – |
| Sex | ||||||
| male | reference | reference | reference | |||
| female |
2.20 (0.84–5.75) |
0.109 |
2.58 (0.95–7.02) |
0.064 |
2.61 (1.00–6.79) |
0.049* |
| Allergic history | ||||||
| negtive | reference | reference | reference | |||
| positive |
4.74 (1.65–13.62) |
0.004* |
5.46 (1.84–16.15) |
0.002* |
5.72 (1.99–16.45) |
0.001* |
| eGFR |
0.99 (0.97–1.00) |
0.119 | – | – | – | – |
| ≥ 60 ml/min/l | – | – | reference | reference | ||
| < 60 ml/min/l | – | – |
6.20 (1.97–19.47) |
0.002* |
5.85 (1.96–17.42) |
0.002* |
| Arteries/veins | ||||||
| Arteries | reference | reference | – | – | ||
| veins |
0.74 (0.23–2.41) |
0.618 |
0.85 (0.26–2.79) |
0.784 | – | – |
| Embolization | ||||||
| No | reference | reference | reference | |||
| Yes |
2.51 (0.68–9.20) |
0.165 |
2.48 (0.65–9.47) |
0.185 |
3.29 (1.20–8.98) |
0.020* |
| Iodine contrast agent | ||||||
| ipromide | reference | reference | – | – | ||
| iodixanol |
0.64 (0.26–1.59) |
0.335 |
0.80 (0.31–2.06) |
0.647 | – | – |
| Iodine contrast agent |
1.00 (1.00–1.01) |
0.074 | – | – | – | – |
| ≤ 400 ml | – | – | reference | reference | ||
| > 400 ml | – | – |
22.50 (2.56–197.58) |
0.005* |
23.34 (2.93–185.74) |
0.003* |
The Hosmer–Lemeshow test indicated a goodness of fit (p > 0.05) for all models.
The results indicated that sex had a statistically significant effect on PONV following endovascular interventional therapy (OR = 2.61; 95% CI: 1.00–6.79; p = 0.049). Female patients were 2.61 times more likely to experience PONV than male patients. Additionally, a positive allergy history was found to have a statistically significant influence (OR = 5.72; 95% CI: 1.99–16.45; p = 0.001). Patients with a positive allergy history had a 4.72-fold higher risk of nausea and vomiting than those without an allergy history. Furthermore, an eGFR < 60 ml/min/1.73 m² was significantly associated with PONV (OR = 5.85; 95% CI: 1.96–17.42; p = 0.002). Patients with chronic kidney disease (CKD) stage 3 or higher prior to the procedure exhibited a 4.85-fold increased risk of PONV after endovascular interventional therapy compared wtih patients with normal renal function or CKD stage 1/2. The use of an iodine contrast agent > 400 ml was also significantly associated with PONV occurrence (OR = 23.34; 95% CI: 2.93–185.74; p = 0.003). Patients who received more than 400 ml of an iodine contrast agent during the procedure had a 22.34-fold increased risk of nausea and vomiting compared to those who received less than 400 ml. Finally, the intervention type of embolization was significantly associated with PONV (OR = 3.29; 95% CI: 1.20–8.98; p = 0.020).
Discussion
In this study, the clinical characteristics of 25 patients with PONV following endovascular intervention were compared with those of 294 control patients. A multivariate logistic regression model was used to identify the risk factors associated with PONV in the endovascular intervention group. The results indicated that sex (female), a history of allergies, renal insufficiency, the use of high–dose iodine contrast agent, and the intervention type of embolization significantly increased the risk of PONV.
Female sex is recognized as a significant risk factor for PONV. In a study focusing on female patients, the incidence of PONV substantially varied across randomized controlled trials in which a placebo or no prophylactic measures were administered. However, more consistent results were observed among patients who received one or two prophylactic interventions. Despite various efforts, a considerable number of female patients still experience notable PONV15. Furthermore, another study revealed four well-established risk factors for PONV: female sex, nonsmoking status, a history of PONV or motion sickness, and postoperative opioid use. Among these, female sex emerged as the strongest predictor (OR = 4.89; p = 0.001)16. Despite the notable differences in anaesthesia and surgical procedures between the patients included in our study and those in previous research, sex remained a crucial risk factor for PONV. Therefore, assessments of the risk factors for PONV and the implement of appropriate prophylactic measures before surgery are essential, particularly for female patients. This approach not only enhances patient comfort but also reduces the occurrence of postoperative complications.
The iodine contrast agent is primarily excreted by the kidneys without undergoing metabolism. This characteristic suggests that iodine contrast agents potentially impact renal function under certain circumstances, especially in patients with impaired renal function17. Studies have shown that the use of iodine contrast agent may lead to transient fluctuations in renal function but typically does not cause long–term renal injury18,19. Our study revealed that the excessive use of iodine contrast agents and renal insufficiency were risk factors for PONV, consistent with the excretion characteristics of these agents. Therefore, this study emphasizes the importance of carefully assessing renal function and estimating the potential dose of contrast agent before an endovascular intervention. However, whether more aggressive prophylactic measures for PONV should be adopted for patients receiving high doses of contrast agent and those with renal insufficiency should be investigated further.
A positive allergy history was also identified as a risk factor for PONV in this study. However, the retrospective data included in our study may not have accurately captured the allergy histories of the two patient groups, adding instability to these findings. In medical practice, manifestations of other conditions are often mistakenly reported as allergies. For example, in a study of penicillin allergy, only a minority of patients’ self–reported allergy histories could be confirmed through objective testing, with many patients not actually having immune–mediated allergic reactions20. Therefore, the finding that patients with a positive allergy history are prone to PONV remains unstable and may have other underlying reasons, requiring further analysis.
Nausea and vomiting, collectively termed postembolization syndrome (PES) along with fever and pain, are frequently observed adverse effects following embolization procedures21–23. Initially, embolization was evaluated alongside six other interventional types, requiring multiple post–hoc comparisons with Bonferroni correction. The difference in embolization approached statistical significance. Therefore, we incorporated embolization as a separate covariate in the multivariate regression analysis, identifying nontargeted-specific embolization as a significant independent risk factor for PONV and facilitating holistic PONV management in endovascular practice.
Previous studies have identified a younger age and increased anaesthesia duration as independent risk factors for PONV24. However, our findings suggest that neither age nor the operation duration significantly contributes to the incidence of PONV following an endovascular intervention. This discrepancy may originate from the specific context of endovascular interventions in our study, which included two cohorts of patients with a mean age exceeding 55 years, all of whom underwent procedures under local or monitored anaesthesia with minimal lidocaine administration. In addition, a younger age and a longer duration of anaesthesia are uncommon in endovascular interventions, making an investigation of the unique risk factors for PONV in endovascular interventions valuable.
Based on these findings, we recommend implementing proactive nursing strategies in clinical practice for high-risk patients, such as preoperative assessments of allergy history and renal function, optimization of the dosage of iodinated contrast agent, and enhanced postoperative monitoring, to reduce the incidence and severity of postoperative vomiting, thereby improving the patient’s experience and satisfaction.
Limitations
This study was a single-centre case–control investigation with a small sample size, which inherently exhibits limitations associated with its retrospective design. While potential risk factors for PONV were identified, the causal relationships between these factors and PONV outcomes remain unclear. Notably, only 319 patients with complete data were included from an initial pool of 1,668 potential participants, introducing potential nonnegligible selection bias. Future research would benefit from multicentre, large-sample case–control or cohort studies to further elucidate unique PONV risk factors specific to endoluminal interventions while validating preliminary findings through more robust methodological designs.
Conclusions
Patients who are female, have a history of allergies, exhibit renal insufficiency, receive embolization, or have received high–dose iodinated contrast agent demonstrated a significantly increased risk of PONV. These findings underscore the importance of implementing proactive nursing strategies for high–risk patients.
Supplementary Information
Below is the link to the electronic supplementary material.
Author contributions
L.F. wrote the main manuscript text, M.Q. prepared Tables 1, 2, 3, 4 and 5, S.Q. prepared Figs. 1, 2 and 3 and X.Z. and C.H. designed research protocols and statistical methods. All authors reviewed the manuscript.
Funding
No funding was received for conducting this study.
Data availability
The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Ethics and consent to participate
not applicable.
Consent to publish
All authors have reviewed the manuscript and approved its submission to Scientific Reports.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Fan Lilin and Qiao Mingyue contributed equally to this work.
Contributor Information
Xichuan Zheng, Email: zhengxichuan@tmmu.edu.cn.
Chunfang Hu, Email: huchunfang@tmmu.edu.cn.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.