Background <p>The reported incidence of postoperative nausea and vomiting (PONV) after laparoscopic bariatric surgery is up to 60–80%. Hower, studies are limited, and larger studies are warranted. As PONV is usually evaluated in the post-anesthesia care unit (PACU), studying early PONV can be a valuable tool for exploring risk and associated factors for PONV.</p> Methods <p>Using prospectively collected data from the Swedish perioperative registry (SPOR) from 2016 to 2022, we explore the incidence and associated factors for early PONV after laparoscopic bariatric surgery. Laparoscopic gastric bypass and laparoscopic gastric sleeve procedures in adult patients (≥ 18&#xa0;years) were included. The primary outcome was the incidence of PONV in the PACU. Secondary outcomes were factors associated with PONV, which were analyzed using a multivariate logistic regression model.</p> Results <p>In total, 14,098 procedures were identified in the registry during the study period, and 8426 unique patients from 32 hospitals in Sweden were included in the final study cohort. PONV in PACU was present in 36% (<i>n</i> = 3018) of patients. Factors associated with early PONV were female sex, age, moderate-severe pain, gastric sleeve procedures, duration in PACU, and hospital.</p> Conclusions <p>In this national register-based cohort study, one third of patients experienced early PONV in the PACU after laparoscopic bariatric surgery. Several risk factors were associated with increased occurrence of PONV, and there was variability among hospitals in the incidence of PONV.</p> <p>Clinicaltrials.gov: NCT04433676</p>