The discriminating power of a risk score for postoperative vomiting in adults undergoing various types of surgery

Apfel, Christian C.; Greim, Clemens‐Alexander; Haubitz, Imme; Grundt, D.; Goepfert, Christine; Sefrin, Peter; Roewer, Norbert

doi:10.1111/j.1399-6576.1998.tb05158.x

Cited by 117 publications

(69 citation statements)

References 19 publications

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“…A number of factors, including age, obesity, history of motion sickness or previous PONV, menstrual cycle, surgical procedure and postoperative pain, are considered to increase the incidence of PONV. 25,26 One can note that the incidence of PONV following SAB in our study is higher in both the intervention and control groups than that in the reported literature. 8,13,16 We attribute this to the major gynaecological surgery and female sex that we chose in our study as both are considered as significant risk factors for PONV in themselves.…”

Section: -11contrasting

confidence: 53%

Postoperative Nausea and Vomiting in Patients Undergoing Total Abdominal Hysterectomy Under Subarachnoid Block: A Randomized Study of Dexamethasone Prophylaxis

Khatiwada

Bhattarai

Biswas

et al. 2013

Kathmandu Univ. Med. J.

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BackgroundPostoperative nausea and vomiting is a common distressing problem in patients undergoing gynaecological surgery under anaesthesia including central neuraxial blockade, which requires frequent medical interventions. ObjectivesWe aimed to find out the antiemetic effect of prophylactic dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under subarachnoid block. Influences of dexamethasone on patient satisfaction and postoperative analgesia were also observed as secondary objectives. MethodsThis was a prospective, randomized, double blind, placebo controlled study conducted in BPKIHS,

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Section: -11contrasting

confidence: 53%

Postoperative Nausea and Vomiting in Patients Undergoing Total Abdominal Hysterectomy Under Subarachnoid Block: A Randomized Study of Dexamethasone Prophylaxis

Khatiwada

Bhattarai

Biswas

et al. 2013

Kathmandu Univ. Med. J.

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“…11,12 Third, the patients underwent both the predictive tests and measurement of the outcome (reference standard), i.e., in this setting, the recording of PONV. Nevertheless, Sinclair, Chung and Mezei defined PONV as "any volunteered report of nausea or observed active retching or vomiting requiring antiemetics" whereas Apfel and co-workers, like their predecessors 13,14 systematically asked for and recorded any episode of nausea and vomiting.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, the impact of the type of surgery among centres appears to be conflicting 5,12,15 with some studies showing no significant effect at all. 11,14 More interestingly, even if the type of surgery had a statistically significant effect, an operation independent score performed equally well as a more complex score considering the type of surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Plutniak

Benais

Pouymayou

2002

Can J Anesth/J Can Anesth

169

108

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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.

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“…Previous studies [8,9] have shown that female gender, longer anesthesia time, general anesthesia, not smoking, use of postoperative opioids and previous PONV and/or motion sickness were associated with increased incidence and severity of PONV. Although less important, PONV may also be influenced by the type of surgery as well: strabismus correction and laparoscopic surgery especially have been described as risk factors for PONV [10,11] . Most of the previous studies that addressed the effect of gabapentin on reducing PONV incidence and severity have been performed on laparoscopic surgery procedures [1,12] .…”

Section: Discussionmentioning

confidence: 99%

Effects of Preoperative Gabapentin on Postoperative Nausea and Vomiting after Open Cholecystectomy: A Prospective Randomized Double-Blind Placebo-Controlled Study

et al. 2009

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Objective: To evaluate the effect of gabapentin on the incidence and severity of postoperative nausea and vomiting (PONV) after open cholecystectomy. Subjects and Methods: A total of 90 patients scheduled for elective open cholecystectomy were randomly assigned to either a gabapentin group (600 mg, 2 h before surgery) or a placebo group. For the analysis, 1 patient was excluded from the gabapentin group and 2 patients from the placebo group. A standard technique was used for anesthesia. Pethidine and metoclopramide were used for postoperative management of pain and nausea/vomiting, respectively. The prevalence of PONV, its severity (measured on visual analogue scale, VAS), and total pethidine and metoclopramide use in the first 24 h after the operation were recorded. Results: There were no demographic differences between the two groups. Of the 44 patients given gabapentin, 16 (36.6%) and 28 of 43 (65.2%) placebo patients developed PONV; the difference was statistically significant (p = 0.02). However, there was no difference in the severity of PONV between the gabapentin and placebo groups (p = 0.12). Gabapentin patients used less pethidine (28.33 ± 129 mg) and metoclopramide (6.0 ±6.3 mg) than the placebo group (35.1 ± 15.1 and 9.33 ± 7.1 mg, respectively). The differences were statistically significant (pethidine: p = 0.002, metoclopramide: p = 0.033). However, gabapentin did not reduce postoperative pain significantly (p = 0.096). Conclusion: Our data show that gabapentin not only reduced PONV after open cholecystectomy, but also reduced the need for additional postoperative analgesics.

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The discriminating power of a risk score for postoperative vomiting in adults undergoing various types of surgery

Abstract: Score I was accurate in predicting PV in patients after most types of surgery with volatile anaesthetics, which suggests that this score might be useful for other centres as well.

Cited by 117 publications

References 19 publications

Postoperative Nausea and Vomiting in Patients Undergoing Total Abdominal Hysterectomy Under Subarachnoid Block: A Randomized Study of Dexamethasone Prophylaxis

Postoperative Nausea and Vomiting in Patients Undergoing Total Abdominal Hysterectomy Under Subarachnoid Block: A Randomized Study of Dexamethasone Prophylaxis

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

Effects of Preoperative Gabapentin on Postoperative Nausea and Vomiting after Open Cholecystectomy: A Prospective Randomized Double-Blind Placebo-Controlled Study

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