(Poster 141) PONV in Robotic Gynecologic Surgery: Scoping out a Solution

Objectives: The aim of this study was to determine if prophylactic application of standard dose (1.5 mg) transdermal scopolamine patch (TDS) reduces the incidence of postoperative nausea and vomiting (PONV) in patients undergoing benign robotic gynecologic surgery.

Methods: We conducted a retrospective cohort study comparing patients that received preoperative TDS to patients that did not receive TDS prior to robotic surgery. Participants were included if they underwent robotic gynecologic surgery for benign conditions between October 2020 and October 2023. The primary outcome was the incidence of PONV. Secondary outcomes included rate of adverse events, time to discharge, and doses of abortive antiemetics required in the recovery room. Results were analyzed using independent samples t-test, Mann-Whitney test, and Chi-Squared test, as appropriate. For this analysis, p < 0.05 was considered statistically significant.

Results: We reviewed 1,071 charts of patients that underwent robotic benign gynecologic surgery from October 2020 to October 2023. Charts were grouped by surgery indication (abnormal uterine bleeding, benign pelvic mass, prolapse, pain, prophylaxis for high-risk genetics, and fistula/other), and block randomization was utilized to guide chart review until desired power was achieved (Figure 1). Sixty-eight patients received prophylactic TDS, and 163 patients did not receive prophylactic TDS. Baseline characteristics were similar between both groups. The incidence of PONV was 36.8% for the TDS group and 39.9% for the non-TDS group, p = 0.66 (Table 1). When length of surgery was accounted for in a logistic regression model, neither length of surgery nor TDS use were significant predictors of PONV (p = 0.75 and 0.61, respectively). No adverse events were identified, and there was no statistically significant difference in doses of abortive antiemetics between the two groups (p = 0.39). Patients in the TDS group spent a longer time in recovery compared to patients in the non-TDS group (p = 0.01); however, there was no statistically significant difference in recovery time between those who experienced PONV and those who did not (p = 0.16).

Conclusions: Current guidelines recommend prophylactic antiemetic treatment for patients at high risk for PONV, such as those undergoing robotic gynecologic surgery. TDS is an attractive antiemetic option due to its low cost and ease of use; however, the results of this retrospective cohort study suggest that use of prophylactic TDS for benign robotic gynecologic surgery does not reduce the incidence of PONV.

Figure 1) AHS: Atlantic Health System; CMC: Chilton Medical Center; MMC: Morristown Medical Center; OMC: Overlook Medical Center; TDS: Transdermal scopolamine

Table 1) IQR: interquartile range; *Based on the number of patients in each group who received abortive antiemetics (n=25 for the TDS group, n = 64 for the no TDS group)