Dynamic predictive model for postoperative nausea and vomiting for intravenous fentanyl patient‐controlled analgesia

Abstract

Summary Postoperative nausea and vomiting is the most common side‐effect of opioid‐based intravenous patient‐controlled analgesia. Apfel's simplified risk score is popular but it has some limitations. We developed and validated a dynamic predictive model for nausea or vomiting up to 48 postoperative hours, available as an online web application. Fentanyl was used by 22,144 adult patients for analgesia after non‐cardiac surgery under general anaesthesia: we randomly divided them into development (80%) and validation (20%) cohorts, repeated 100 times. We used linear discriminant analysis to select variables for multivariate logistic regression. The incidences of postoperative nausea or vomiting were: 0–48 h, 5691/22,144 (26%); 0–6 h, 2749/22,144 (12%); 6–12 h, 2687/22,144 (12%); 12–18 h, 2624/22,144 (12%); 18–24 h, 1884/22,144 (9%); and 24–48 h, 1082/22,144 (5%). The median (95%CI) area under the receiver operating characteristic curve was 0.72 (0.71–0.73) up to 48 postoperative hours compared with 0.65 (0.64–0.66) for the Apfel model, p < 0.001. The equivalent areas for 0–6 h, 6–12 h, 12–18 h, 18–24 h and 24–48 h were: 0.70 (0.69–0.72); 0.71 (0.69–0.73); 0.69 (0.68–0.71); 0.70 (0.67–0.72); and 0.69 (0.66–0.71), respectively. Our web application allows clinicians to calculate incidences of nausea and vomiting in patients receiving intravenous fentanyl for patient‐controlled analgesia.

<p>Effect of Fentanyl-Based Intravenous Patient-Controlled Analgesia with and without Basal Infusion on Postoperative Opioid Consumption and Opioid-Related Side Effects: A Retrospective Cohort Study</p>

“…1 Nonetheless, IV-PCA with basal fentanyl infusion is still used. [12][13][14][15] Most of the evidence regarding this issue has been deduced from morphine-based IV-PCA in studies that included a relatively small number of patients. [8][9][10] Due to the different pharmacokinetic properties of fentanyl, evidence of the risks and benefits of basal infusion in fentanyl-based IV-PCA is required.…”

Machine learning for prediction of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia

“…The increase in PONV with the use of preintubation opioids or laparoscopic surgery is evidenced in previous studies [ 27 , 28 ]. Hypotension occurring during shoulder surgery may be a major factor of PONV and was used as one of the features in our study [ 12 , 29 ].…”

“…However, the Apfel model does not guarantee the accurate prediction of the risk of PONV, with limited discrimination and calibration properties [10,11]. Recently, studies have used dynamic predictive models or machine learning to improve the predictive performance of PONV [12][13][14][15].…”

Wound infiltration with ropivacaine as an adjuvant to patient controlled analgesia for transforaminal lumbar interbody fusion: a retrospective study

“…The decreased rate of PONV that was observed in ropivacaine group may be related to less opioid consumption consumed by patients receiving wound infiltration with ropivacaine, which was similar to Li’s report from a randomized controlled trial [ 26 ]. PONV was also an unpleasant side effect feared by many patients during acute postoperative course, which can also cause dehydration, electrolyte imbalance, postoperative bleeding, wound dehiscence, and pulmonary aspiration [ 27 , 28 ]. Hence, in addition to improving patient experience, the lower rate of PONV may also contribute to shorter length of hospital duration.…”