Latent classes and influencing factors of postoperative nausea and vomiting trajectories in patients undergoing open posterior spinal surgery_West China Medical Journal

Authors：

WANG Wei , TIAN Xue , LIU Tian , HE Xiaoyan , ZHANG Lin , HAO Fujie , CHEN Ziyan ,  CHEN Yaping

Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P. R. China;

Corresponding?author：

CHEN Yaping, Email: 18612672357@139.com

Keywords：

Spinal surgery; postoperative nausea and vomiting; latent classes; influencing factors

DOI：

10.7507/1002-0179.202606045

Video：

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Objective To explore the latent classes of developmental trajectories and influencing factors of postoperative nausea and vomiting in patients undergoing open posterior spinal surgery. Methods Patients who underwent open posterior spinal surgery at Peking Union Medical College Hospital between November 2024 and October 2025 were enrolled. Demographic data and clinical data, as well as data on nausea, vomiting, and psychological status from postoperative day 1 to 3, were collected. Latent growth mixture model was used to identify developmental trajectories of PONV. Univariate analysis and binary logistic regression were performed to analyze the influencing factors of the latent postoperative nausea and vomiting classes. Results A total of 201 patients were included. Among them, there were 62 males and 139 females. Two distinct developmental trajectories of postoperative nausea and vomiting were identified by latent growth mixture model: the high risk postoperative nausea and vomiting class (84 patients, 41.8%) and the low risk postoperative nausea and vomiting class (117 patients, 58.2%). Logistic regression showed that a history of abdominal surgery, duration of peak pain on postoperative day 1, a history of previous postoperative nausea and vomiting or motion sickness, time from surgery completion to first oral intake, age and hemoglobin concentration on postoperative day 2 were associated with high risk of postoperative nausea and vomiting. Conclusions Two heterogeneous developmental trajectories of postoperative nausea and vomiting in patients undergoing open posterior spinal surgery were identified using latent growth mixture model, and the independent influencing factors were clarified. Medical staff can formulate targeted prevention and control measures based on the influencing factors of the latent classes, optimize management strategies for postoperative nausea and vomiting in spinal surgery patients, and provide a basis for precise clinical prevention and control of postoperative nausea and vomiting.

Citation： WANG Wei, TIAN Xue, LIU Tian, HE Xiaoyan, ZHANG Lin, HAO Fujie, CHEN Ziyan, CHEN Yaping. Latent classes and influencing factors of postoperative nausea and vomiting trajectories in patients undergoing open posterior spinal surgery. West China Medical Journal, 2026, 41(9): 1426-1432. doi: 10.7507/1002-0179.202606045 Copy

1.	Darvall JN, De Silva AP, von Ungern-Sternberg B. Chewing gum to treat postoperative nausea and vomiting in female patients: a multicenter randomized trial[J]. Anesthesiology, 2025, 142(3): 454-464.
2.	Ma Q, Wang M, Zhang W, et al. Feedback-regulated versus constant-rate sufentanil patient-controlled analgesia for postoperative nausea and vomiting after laparoscopic myomectomy: a randomized controlled trial[J]. Drug Des Devel Ther, 2026, 20: 597391.
3.	Huang X, Deng S, Lei X, et al. Effect of enhanced recovery after surgery on older patients undergoing transvaginal pelvic floor reconstruction surgery: a randomised controlled trial[J]. BMC Med, 2025, 23(1): 43.
4.	Timerga S, Befkadu A. Prevalence and associated factors of postoperative nausea and vomiting among adult patients undergoing elective surgery[J]. Ann Med Surg (Lond), 2024, 86(3): 1304-1308.
5.	Ju JW, Kwon J, Yoo S, et al. Retrospective analysis of the incidence and predictors of postoperative nausea and vomiting after orthopedic surgery under spinal anesthesia[J]. Korean J Anesthesiol, 2023, 76(2): 99-106.
6.	Lin Y, Tiansheng S, Zhicheng Z, et al. Effects of ramosetron on nausea and vomiting following spine surgery: a meta-analysis[J]. Curr Ther Res Clin Exp, 2022, 96: 100666.
7.	Liao XQ, Li SL, Peng YC, et al. Effects of chewing gum on gastrointestinal function in patients following spinal surgery: a meta-analysis and systematic review[J]. Eur Spine J, 2022, 31(10): 2536-2546.
8.	Chen M, Wu D, Chen F, et al. Intravenous lidocaine simultaneously infused with sufentanil to accelerate gastrointestinal function recovery in patients after thoracolumbar surgery: a prospective, randomized, double-blind controlled study[J]. Eur Spine J, 2023, 32(1): 313-320.
9.	Kim SY. Sample size requirements in single-and multiphase growth mixture models: a monte carlo simulation study[J]. Struct Equ Model, 2012, 19(3): 457-476.
10.	Syed AN, Baghdadi S, Muhly WT, et al. Nausea and vomiting after posterior spinal fusion in adolescent idiopathic scoliosis: a systematic and critical analysis review[J]. JBJS Rev, 2024, 12(1). DOI: 10.2106/JBJS.RVW.23.00176.
11.	曾夢婷, 何虹, 劉淑華, 等. 術后惡心嘔吐預測模型的研究進展[J]. 護理研究, 2023, 37(20): 3701-3704.
12.	馮丹丹, 賈銳, 馬正良, 等. 青少年特發性脊柱側凸術后發生惡心嘔吐的危險因素分析[J]. 南方醫科大學學報, 2020, 40(3): 394-399.
13.	吳覺倫, 田園, 聶衛華, 等. 手術患者接受患者自控靜脈鎮痛期間發生術后惡心嘔吐的危險因素分析[J]. 協和醫學雜志, 2024, 15(2): 366-374.
14.	Yao YC, Liou JY, Wang HY, et al. Benefits of early recovery after surgery (ERAS) protocols on perioperative outcomes in patients undergoing elective lumbar spinal fusion: a prospective study[J]. Spine J, 2025, 25(8): 1588-1595.
15.	Boogaerts JG, Vanacker E, Seidel L, et al. Assessment of postoperative nausea using a visual analogue scale[J]. Acta Anaesthesiol Scand, 2000, 44(4): 470-474.
16.	Ursava? FE, Baksi A, Sar?ca E. Postoperative nausea and vomiting after orthopaedic surgery: prevalence and associated factors[J]. Orthop Nurs, 2023, 42(3): 179-187.
17.	Yokoyama T, Tamura T, Nishida K, et al. Anxiety evaluated by the hospital anxiety and depression scale as a predictor of postoperative nausea and vomiting: a pilot study[J]. Nagoya J Med Sci, 2024, 86(1): 72-81.
18.	Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A)[J]. Arthritis Care Res (Hoboken), 2011, 63 (Suppl 11): S467-S472.
19.	倪韶青, 漆林艷, 李春梅, 等. 兒科臨床研究的知情同意[J]. 臨床兒科雜志, 2017, 35(3): 236-240.
20.	張燕, 楊旭, 陳亞萍, 等. 脊柱側凸矯形術患兒術后惡心嘔吐發生現狀及其影響因素分析[J]. 中華現代護理雜志, 2019, 25(36): 4734-4739.
21.	中華醫學會麻醉學分會《術后惡心嘔吐診療指南(2025 版)》工作組. 術后惡心嘔吐診療指南 (2025 版)[J]. 中華麻醉學雜志, 2025, 45(9): 1080-1103.
22.	鄭婷婷, 劉瑩, 張威, 等. 468 例骨科患者術后惡心嘔吐發生情況及相關影響因素分析[J]. 臨床藥物治療雜志, 2019, 17(8): 66-69, 85.
23.	Venara A, Neunlist M, Slim K, et al. Postoperative ileus: pathophysiology, incidence, and prevention[J]. J Visc Surg, 2016, 153(6): 439-446.
24.	Paterson H, Vadiveloo T, Innes K, et al. Intravenous lidocaine for gut function recovery in colonic surgery: a randomized clinical trial[J]. JAMA, 2025, 333(1): 39-48.
25.	Kong Q, Wang W, Chen XY, et al. Study protocol: a randomized controlled clinical trial on the use of electroacupuncture for postoperative abdominal distension following laparoscopic cholecystectomy[J]. Front Surg, 2025, 12: 1557431.
26.	Apfel CC, L??r? E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers[J]. Anesthesiology, 1999, 91(3): 693-700.
27.	Bao K, Deng Y, Zhao X, et al. Effects of liberal oral intake on postoperative outcomes after elective laparoscopic gynaecological surgery: a randomised controlled clinical trial[J]. J Hum Nutr Diet, 2022, 35(6): 1079-1086.
28.	Singh R, Huligeri HS, Singh P. A randomised controlled trial to compare the occurrence of postoperative nausea and vomiting in early versus conventional feeding in children undergoing daycare surgery under general anaesthesia[J]. Indian J Anaesth, 2024, 68(9): 815-820.
29.	陳凜, 陳亞進, 董海龍, 等. 加速康復外科中國專家共識及路徑管理指南 (2018 版)[J]. 中國實用外科雜志, 2018, 38(1): 1-20.
30.	Knoth S, Weber B, Lotz H, et al. Update PO(N)V-What is new in the prophylaxis and treatment of postoperative nausea and vomiting?[J]. Anaesthesiologie, 2025, 74(3): 171-186.

1. Darvall JN, De Silva AP, von Ungern-Sternberg B. Chewing gum to treat postoperative nausea and vomiting in female patients: a multicenter randomized trial[J]. Anesthesiology, 2025, 142(3): 454-464.
2. Ma Q, Wang M, Zhang W, et al. Feedback-regulated versus constant-rate sufentanil patient-controlled analgesia for postoperative nausea and vomiting after laparoscopic myomectomy: a randomized controlled trial[J]. Drug Des Devel Ther, 2026, 20: 597391.
3. Huang X, Deng S, Lei X, et al. Effect of enhanced recovery after surgery on older patients undergoing transvaginal pelvic floor reconstruction surgery: a randomised controlled trial[J]. BMC Med, 2025, 23(1): 43.
4. Timerga S, Befkadu A. Prevalence and associated factors of postoperative nausea and vomiting among adult patients undergoing elective surgery[J]. Ann Med Surg (Lond), 2024, 86(3): 1304-1308.
5. Ju JW, Kwon J, Yoo S, et al. Retrospective analysis of the incidence and predictors of postoperative nausea and vomiting after orthopedic surgery under spinal anesthesia[J]. Korean J Anesthesiol, 2023, 76(2): 99-106.
6. Lin Y, Tiansheng S, Zhicheng Z, et al. Effects of ramosetron on nausea and vomiting following spine surgery: a meta-analysis[J]. Curr Ther Res Clin Exp, 2022, 96: 100666.
7. Liao XQ, Li SL, Peng YC, et al. Effects of chewing gum on gastrointestinal function in patients following spinal surgery: a meta-analysis and systematic review[J]. Eur Spine J, 2022, 31(10): 2536-2546.
8. Chen M, Wu D, Chen F, et al. Intravenous lidocaine simultaneously infused with sufentanil to accelerate gastrointestinal function recovery in patients after thoracolumbar surgery: a prospective, randomized, double-blind controlled study[J]. Eur Spine J, 2023, 32(1): 313-320.
9. Kim SY. Sample size requirements in single-and multiphase growth mixture models: a monte carlo simulation study[J]. Struct Equ Model, 2012, 19(3): 457-476.
10. Syed AN, Baghdadi S, Muhly WT, et al. Nausea and vomiting after posterior spinal fusion in adolescent idiopathic scoliosis: a systematic and critical analysis review[J]. JBJS Rev, 2024, 12(1). DOI: 10.2106/JBJS.RVW.23.00176.
11. 曾夢婷, 何虹, 劉淑華, 等. 術后惡心嘔吐預測模型的研究進展[J]. 護理研究, 2023, 37(20): 3701-3704.
12. 馮丹丹, 賈銳, 馬正良, 等. 青少年特發性脊柱側凸術后發生惡心嘔吐的危險因素分析[J]. 南方醫科大學學報, 2020, 40(3): 394-399.
13. 吳覺倫, 田園, 聶衛華, 等. 手術患者接受患者自控靜脈鎮痛期間發生術后惡心嘔吐的危險因素分析[J]. 協和醫學雜志, 2024, 15(2): 366-374.
14. Yao YC, Liou JY, Wang HY, et al. Benefits of early recovery after surgery (ERAS) protocols on perioperative outcomes in patients undergoing elective lumbar spinal fusion: a prospective study[J]. Spine J, 2025, 25(8): 1588-1595.
15. Boogaerts JG, Vanacker E, Seidel L, et al. Assessment of postoperative nausea using a visual analogue scale[J]. Acta Anaesthesiol Scand, 2000, 44(4): 470-474.
16. Ursava? FE, Baksi A, Sar?ca E. Postoperative nausea and vomiting after orthopaedic surgery: prevalence and associated factors[J]. Orthop Nurs, 2023, 42(3): 179-187.
17. Yokoyama T, Tamura T, Nishida K, et al. Anxiety evaluated by the hospital anxiety and depression scale as a predictor of postoperative nausea and vomiting: a pilot study[J]. Nagoya J Med Sci, 2024, 86(1): 72-81.
18. Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A)[J]. Arthritis Care Res (Hoboken), 2011, 63 (Suppl 11): S467-S472.
19. 倪韶青, 漆林艷, 李春梅, 等. 兒科臨床研究的知情同意[J]. 臨床兒科雜志, 2017, 35(3): 236-240.
20. 張燕, 楊旭, 陳亞萍, 等. 脊柱側凸矯形術患兒術后惡心嘔吐發生現狀及其影響因素分析[J]. 中華現代護理雜志, 2019, 25(36): 4734-4739.
21. 中華醫學會麻醉學分會《術后惡心嘔吐診療指南(2025 版)》工作組. 術后惡心嘔吐診療指南 (2025 版)[J]. 中華麻醉學雜志, 2025, 45(9): 1080-1103.
22. 鄭婷婷, 劉瑩, 張威, 等. 468 例骨科患者術后惡心嘔吐發生情況及相關影響因素分析[J]. 臨床藥物治療雜志, 2019, 17(8): 66-69, 85.
23. Venara A, Neunlist M, Slim K, et al. Postoperative ileus: pathophysiology, incidence, and prevention[J]. J Visc Surg, 2016, 153(6): 439-446.
24. Paterson H, Vadiveloo T, Innes K, et al. Intravenous lidocaine for gut function recovery in colonic surgery: a randomized clinical trial[J]. JAMA, 2025, 333(1): 39-48.
25. Kong Q, Wang W, Chen XY, et al. Study protocol: a randomized controlled clinical trial on the use of electroacupuncture for postoperative abdominal distension following laparoscopic cholecystectomy[J]. Front Surg, 2025, 12: 1557431.
26. Apfel CC, L??r? E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers[J]. Anesthesiology, 1999, 91(3): 693-700.
27. Bao K, Deng Y, Zhao X, et al. Effects of liberal oral intake on postoperative outcomes after elective laparoscopic gynaecological surgery: a randomised controlled clinical trial[J]. J Hum Nutr Diet, 2022, 35(6): 1079-1086.
28. Singh R, Huligeri HS, Singh P. A randomised controlled trial to compare the occurrence of postoperative nausea and vomiting in early versus conventional feeding in children undergoing daycare surgery under general anaesthesia[J]. Indian J Anaesth, 2024, 68(9): 815-820.
29. 陳凜, 陳亞進, 董海龍, 等. 加速康復外科中國專家共識及路徑管理指南 (2018 版)[J]. 中國實用外科雜志, 2018, 38(1): 1-20.
30. Knoth S, Weber B, Lotz H, et al. Update PO(N)V-What is new in the prophylaxis and treatment of postoperative nausea and vomiting?[J]. Anaesthesiologie, 2025, 74(3): 171-186.

West China Medical Journal

Latent classes and influencing factors of postoperative nausea and vomiting trajectories in patients undergoing open posterior spinal surgery

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