Aprepitant and Postoperative Nausea and Vomiting in Patients Undergoing Acoustic Neuroma Surgery: A Retrospective Database Analysis

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications, leading to prolonged hospital stays and reduced patient satisfaction. Acoustic neuroma (AN) resections are associated with a higher risk of PONV than other craniotomies. We aimed to detect if preoperative aprepitant is associated with less PONV following AN surgery. METHODS: Perioperative data were collected from the electronic medical record for patients undergoing AN resection between December 19, 2017 and April 26, 2022. Variables were compared between a cohort that received aprepitant and a matched cohort. Univariable and multivariable regression analyses were performed. Our primary outcome was PONV on the day of surgery. RESULTS: A total of 579 patients were included, of which 49% (n=283) developed PONV. A cohort of 108 patients who received aprepitant was matched in a 1:2 manner. Aprepitant was not associated with reduced PONV ( P =0.239, odds ratio=0.756 [95% CI: 0.475-1.204]). On the basis of our univariable logistic regression model, tumor size, a translabyrinthine approach, total dose of propofol, total volume of crystalloids, highest nitrous oxide concentration, and anesthetic duration were associated with decreased odds of PONV. In multivariable regression modeling, none of these characteristics were associated with decreased odds of PONV. CONCLUSION: Our results confirm that PONV is a common complication following AN resection. Preoperative aprepitant administration was not associated with reduced PONV. Intraoperative variables such as the surgical approach and duration of anesthesia might play a role in mitigating the risk of PONV. Future studies should identify other perioperative interventions to allow for the development of protocols addressing PONV.