Postoperative nausea and vomiting: a comparative survey of the attitudes, perceptions, and practice of Swiss anesthesiologists and surgeons.

Managing postoperative nausea and vomiting (PONV) depends on awareness of the problem, the therapeutic measures available, and effective implementation control systems. We mailed 616 PONV questionnaires to all 129 Swiss hospitals with anesthesiological and surgical departments. The responses [192 (31%) completed questionnaires from 87 (67%) hospitals] are representative of Swiss hospital anesthesiologists and surgeons. Anesthesiologists' perceptions of PONV are closer to those found in the literature than surgeons'. More than three quarters of anesthesiologists and less than half of surgeons practice PONV prophylaxis. Half of the respondents are dissatisfied with present antiemetics. Anesthesiologists worry about the cost of PONV prophylaxis, and surgeons are concerned about their lack of theoretical knowledge. Formal PONV policies are rare, with little consensus on treatment responsibilities. Sixty percent of respondents document PONV occurrence, and less than 20% perform any formal PONV audit. This survey identifies factors amenable to improvement regarding PONV management in Swiss hospitals. PONV education is a necessity, particularly for surgeons. Cost needs to be addressed with anesthesiologists. The limited therapeutic efficacy of antiemetics is a concern. PONV management needs standardization, organization, consensus, and research. Better audits and visibility in patients' charts could further improve the quality of PONV management.