2026 Poster Presentations
P464: EFFECT OF PRE-OPERATIVE APREPITANT ADMINISTRATION ON POST-OPERATIVE NAUSEA AND VOMITING IN ANTERIOR SKULL BASE SURGERY
Anuj Patel, MD, MS; Cynthia Sun, BS; Hewitt Chang, BS; Jared Clouse, MD; Kiarash Shahlaie, MD, PhD; E. Bradley Strong, MD; Toby Steele, MD; University of California, Davis
Post-operative nausea and vomiting (PONV) is common following sinonasal and skull base surgeries, with reported incidence between 15-80%. Aprepitant is a neurokinin-1 receptor antagonist which has been demonstrated to reduce PONV across multiple surgical procedures, including in trans-sphenoidal skull base surgery. This study aims to investigate the incidence of PONV in patients who received pre-operative aprepitant prior to undergoing skull base surgery. A retrospective review of 63 patients undergoing endoscopic skull base surgery at an academic institution was performed between January 2024 and August 2025. Age, sex, smoking status, and prior history of PONV were collected. Anesthesia type, procedural time, presence of intraoperative CSF leak, and preoperative administration of medications known to impact PONV, such as ondansetron and dexamethasone, were also collected. The primary outcome was the incidence of PONV events as documented in the post-operative notes as well as the administration of rescue anti-emetic therapy. Post-operative bleeding was a secondary outcome and was defined as a bleeding event requiring emergency department presentation. Multivariate regression models and matching analyses were performed in R. Of the 63 cases, 22 patients received pre-operative aprepitant. There were no significant differences in age, sex, smoking status, or prior history of PONV between aprepitant and non-aprepitant groups. In multivariate regression analyses adjusting for age, sex, TIVA use, PONV history, smoking, ASA score, procedural time, and presence of intraoperative CSF leak, there was no significant difference in PONV between the aprepitant group and non-aprepitant group (OR 1.01, CI: 0.31 – 3.27, p = 0.99). In matching analyses, there was no statistical difference between incidence of PONV between aprepitant and non-aprepitant groups after matching for age, sex, smoking, and history of PONV (38.1% vs 42.9%, OR 0.86, p = 1.00). There was no difference in vomiting between groups after multivariate regression analysis (OR 0.39, CI: 0.05 – 1.91, p = 0.28) and matching (OR 0.66, CI: 0.15 – 2.8, p = 0.74). Post-operative bleeding rates were similar across groups after matching (9.5% vs 9.5%, OR 1, p = 1.00). Post-operative nausea and vomiting occurs in nearly half of patients undergoing endoscopic skull base surgery. The incidence of PONV following skull base surgery did not significantly differ between those who received aprepitant and those who did not.