PONV risk score and gender as predictors of delayed ambulation in outpatient thyroid and parathyroid surgery.

Abstract

e18087 Background: Enhanced Recovery After Surgery (ERAS) protocols aim to improve perioperative outcomes by promoting early ambulation, which is linked to fewer complications and shorter length of stay. However, in outpatient head and neck surgery, achieving early ambulation is challenging due to airway concerns, discomfort, and postoperative nausea and vomiting (PONV). While inpatient studies have linked delayed ambulation to higher complication rates, longer hospitalizations, and increased opioid use, few studies have examined factors affecting ambulation in the outpatient setting. This is a key gap as ERAS protocols expand to same-day discharge. Identifying predictors of delayed ambulation may help tailor ERAS protocols and allow targeted interventions to improve recovery. Methods: We retrospectively reviewed 1,788 patients undergoing thyroidectomy or parathyroidectomy at the Josie Robertson Surgery Center between January 2016 and December 2022. After exclusion, 1,331 patients were left for analysis. Ambulation was objectively measured using a real-time locating system (RTLS). Delayed ambulation was defined as occurring on the first postoperative day. Multivariable regression adjusted for surgery end time was used to evaluate predictors of delayed ambulation, including age, gender, American Society of Anesthesiologists (ASA) score, operative time, intravenous fluids, estimated blood loss, opioid use, PONV risk score (Apfel score), and perioperative antiemetic use. Results: Median time from recovery room arrival to first ambulation was 5.3 hours (IQR 4.0-7.6), with 19% of patients experiencing delayed ambulation. Delayed ambulation was associated with longer operative time (median 118 minutes vs. 110 minutes; p=0.002), higher intravenous fluids (median 1,250 mL vs. 1,100 mL; p<0.001), and female sex (OR 2.42; 95% CI 1.67, 3.60; p<0.001). Compared to Apfel 1-2 scores, patients with Apfel 3 score had the highest odds of delayed ambulation (OR 2.41; 95% CI 1.67, 3.55). After adjusting for surgery end time and antiemetic use, female sex and Apfel 3 score remained strong predictors of delayed ambulation among patients not receiving preoperative aprepitant (p<0.001). Among those receiving aprepitant, a history of motion sickness or PONV was associated with a reduced risk of delayed ambulation (OR 0.54; p=0.041). Conclusions: Apfel score and female sex were independent predictors of delayed ambulation. High-risk patients may benefit from preoperative aprepitant. Those with a history of motion sickness and PONV have a reduced risk of delayed ambulation. Early risk identification and targeted antiemetic strategies may improve ambulation and recovery in outpatient head and neck surgery.