Apfel’s simplified score may favourably predict the risk of postoperative nausea and vomiting

Abstract

P Pu ur rp po os se e: : To compare two of the latest published scores for predicting postoperative nausea and vomiting (PONV) in potentially high-risk patients. M Me et th ho od ds s: : Adult in-patients scheduled for throat, thyroid, breast or gynecological surgery under general inhalational anesthesia were studied prospectively over 24 hr for PONV. The latest published score considers four risk factors: female gender, previous history of PONV or motion sickness, non-smoking status and postoperative use of opioids (Apfel-score). The previously published score includes, in addition to these factors, duration, type of anesthesia and surgery (Sinclair-score). The two scores were compared by calculating the area under a receiver operating characteristic (ROC)-curve and plotting calibration curves of the predicted and the observed incidence of PONV. R Re es su ul lt ts s: : Five hundred consecutive patients were studied and patients who received prophylactic antiemetics were excluded. Of the remaining 428 patients 49.5% suffered from PONV. Multivariable analysis revealed that age, gender, previous history of PONV or motion sickness and postoperative use of opioids had an impact on PONV. The area under the ROC-curve was significantly greater for the Apfel-score compared to the Sinclair-score (0.71 vs 0.64, P=0.008). The correlation between the predicted (x) and the observed (y) incidence for the Apfel-score and for the Sinclairscore was y=1.08x -0.07 and y=0.93x + 0.27. C Co on nc cl lu us si io on n: : In our hospital, the simplified Apfel-score presented with favourable discriminating and calibration properties for predicting the risk of PONV. Therefore, we have implemented this score in our daily clinical practice as well as in an ongoing antiemetic trial.

Une approche préventive adaptée aux risques réduit l’incidence générale de nausées et de vomissements postopératoires en milieu hospitalier

“…12 In addition, this score showed favourable predictive properties in a French validation study. 14 To make it even simpler, we classified the patients either as "high-risk" for PONV (two or more risk factors with an expected risk for PONV of approximately 40%) or "low-risk" (less than two risk factors and an expected risk for PONV of approximately 20%).…”

The timing of haloperidol administration does not affect its prophylactic antiemetic efficacy

“…10,[21][22][23] Combination of the most important risk factors can be used in an operation-independent risk score to predict the incidence of PONV. 8,9,22,24 In our study, we used Apfel's simplified risk score instead of selecting patients undergoing just one type of surgery. All patients in this study had the same risk score and furthermore, the types of surgery were similar for both groups.…”

“…All patients were female, non-smoking, with a history of motion sickness or/ and PONV (Apfel's simplified risk score = 3). 8,9 The exclusion criteria were obvious airway problems, overweight (body mass index > 25 kg·m -2 ), pregnancy, history of cardiac arrhythmia, chronic cough, psychiatric illness, clinically significant major organ disease, and consumption of any agent with antiemetic properties within 24 hr prior to commencing the study. Preoperative factors that influenced the incidence of PONV, such as history of PONV, or motion sickness were recorded.…”

“…Instead, the observed incidences for both treatment groups were compared to the predicted incidence before treatment, based upon Apfel's simplified risk score for PONV. 8,9 Statistical analysis In this study, all patients had three risk factors for PONV (female, non-smoking, with a history of motion sickness or/and PONV). Based upon the Apfel's simplified risk score, the predicted incidence of PONV amongst our patients before antiemetic treatment was 60%.…”

“…Based upon the Apfel's simplified risk score, the predicted incidence of PONV amongst our patients before antiemetic treatment was 60%. 8,9 Sample size estimation was performed in accordance with the results of our recently published study. 7 In that study, the incidence of PONV was 30% when 2 mg haloperidol was used at the end of surgery.…”