Design: Retrospective chart review and analysis.

Setting: Tertiary care center performing high-volume gynecologic surgery in Seattle, WA.

Patients or Participants: A total of 1,235 adult participants (>18 years old) undergoing inpatient and outpatient laparoscopic and open gynecologic surgery, including benign and malignant conditions.

Interventions: The treatment arm includes patients who were given 0.075mg of palonosetron (N=261) intraoperatively versus the control arm including patients who received standard-of-care (N=974) PONV prophylaxis with ondansetron.

Measurements and Main Results: The average age was similar in both groups, 47 years (SD=13.6). Average operative duration between groups was similar, 126 (SD=55) and 124 (SD=73) minutes for palonosetron and standard-of-care, respectively (p=0.68). In total, 39% (477/1,235) were inpatients and 61% (758/1,235) outpatients. The primary endpoint was incidence of PONV within 24 hours of surgery. Of patients who received palonosetron, 16.1% (42/261) experienced PONV as compared to 25.9% (252/974) of patients who received standard-of-care PONV prophylaxis (p < 0.05). An unadjusted subgroup analysis indicated a reduction in PONV in outpatients who received palonosetron compared to standard-of-care (4.8% vs 11.9%, p=0.0075), whereas inpatient data showed a non-significant trend towards benefit in those that received palonosetron compared to standard-of-care (36.6% vs 47.4%, p=0.059).

Conclusion: Palonosetron confers greater efficacy in prevention of PONV as compared to standard prophylaxis with ondansetron in patients undergoing laparoscopic gynecologic surgery.