Contribution of pharmacist intervention to postoperative nausea and vomiting prophylaxis in routine multidisciplinary practice: a retrospective observational study.

backgroundPostoperative nausea and vomiting (PONV) is a common surgical complication that delays recovery and increases healthcare costs. Although U.S. guidelines recommend multimodal, risk-stratified prophylaxis, Japan lacks unified national guidelines, resulting in practice variation. Despite expanded insurance coverage for 5-HT₃ receptor antagonists, sustained adherence to best practices requires a multidisciplinary framework. We implemented a pharmacist-led, multidisciplinary PONV prevention protocol and evaluated its impact on PONV incidence among adults undergoing elective surgery across multiple specialties.

methodsWe developed a pharmacist-led multidisciplinary PONV prevention protocol based on U.S. guideline algorithms, recommending ≥ 2 and ≥3 prophylactic agents for medium- and high-risk patients, respectively. Pharmacists in the admission support center collected preoperative risk factors, while operating room pharmacists relayed assessments to anesthesiologists and nurses. We conducted a retrospective observational study of patients aged ≥ 18 years undergoing elective gastrointestinal or gynecological surgery under general anesthesia. We compared 110 and 255 patients in the pre- and post-intervention groups, respectively, focusing on patients at medium to high risk. For primary analysis, we performed 1:1 propensity score matching (PSM) using five covariates to control for confounding. Conditional logistic regression evaluated intervention effects while accounting for the matched design.

resultsThe final analysis included 106 controls and 243 intervention patients. PSM produced 103 well-balanced matched pairs (standardized differences < 0.1). Conditional logistic regression showed that the pharmacist-led intervention significantly reduced PONV occurrence (odds ratio [OR] 0.308, 95% confidence interval [CI], 0.139-0.680). Prophylactic agent use increased significantly after the intervention (OR 3.95, 95% CI 2.43-6.54), with dexamethasone (OR 5.92, 95% CI 3.03-11.60) and 5-HT₃ receptor antagonists (OR 4.98, 95% CI 2.69-9.22) showing the largest increases. Dopamine antagonists and total intravenous anesthesia administration also showed upward trends, though without statistical significance.

conclusionsThe implementation of a pharmacist-led multidisciplinary PONV prevention protocol was associated with a lower incidence of PONV in medium- to high-risk patients. Pharmacist-conducted preoperative risk assessment improved the implementation of risk-based prophylaxis within a multidisciplinary framework. These findings suggest that pharmacist-driven collaborative approaches may facilitate more consistent PONV prophylaxis in clinical settings lacking unified guidelines.