Exploring the Relationship Between Body Mass Index and Postoperative Nausea and Vomiting: A Single-Institution Analysis

Document Type

Conference Proceeding

Publication Date

10-11-2025

Abstract

Background: Postoperative nausea and vomiting (PONV) is a common complication following general anesthesia, influenced by patient factors, surgical type, and anesthetic management. Beyond discomfort, PONV can cause dehydration, electrolyte imbalances, and delayed recovery. The relationship between body mass index (BMI) and the development of PONV is controversial, with some studies suggesting higher BMI increases risk, while others propose higher BMI is protective against PONV. Additionally, there is limited evidence on the contribution of neuromuscular blockade reversal agents to PONV in obese patients. This study explores the relationship between BMI and PONV and examines the association between reversal agent choice and PONV across BMI categories at our institution.
Methods: A retrospective analysis was conducted using data from the Multicenter Perioperative Outcomes Group (MPOG) on surgical procedures performed under general anesthesia at Corewell Health East William Beaumont University Hospital. Patients were categorized into five BMI groups: underweight (< 18.5), normal weight (18.5-24.9), overweight (25-29.9), obese (30-39.9), and morbidly obese (≥40). Rates of PONV were analyzed across all surgical procedures, gynecological procedures, and abdominal procedures involving general anesthesia. A subgroup analysis assessed rates of PONV in patients who received sugammadex and neostigmine for neuromuscular blockade reversal.
Results: A total of 391,835 patients were included in the analysis. PONV rates progressively increased with higher BMI for all procedures involving general anesthesia: underweight (2.2%), normal weight (3.3%), overweight (3.1%), obese (3.6%), and morbidly obese (6.1%). We further subdivided procedures into gynecological and abdominal surgeries to assess if surgery type influenced this trend, and the findings remained consistent, with morbidly obese patients consistently exhibiting the highest PONV rates (Fig.1). Among patients receiving sugammadex, PONV rates increased with BMI, peaking at 12.6% in morbidly obese patients across all procedures. In contrast, PONV rates for patients receiving neostigmine followed a similar trend across BMI categories but remained lower overall, with a peak of 4.6% in morbidly obese patients across all procedures (Fig.2).

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American Society of Anesthesiologists, The Anesthesiology Meeting, October 10-14, 2025, San Antonio, TX

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