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Simplified 4-Item Risk Score of Apfel et al Predicting Postoperative Nausea and Vomiting (PONV)

Purpose: To evaluate a patient for risk of postoperative nausea and vomiting (PONV) using the simplified risk score of Apfel et al .

Description

Apfel et al used a simple 4-item risk score to identify patients at increased risk for postoperative nausea and vomiting. This can help identify patients who may benefit from more aggressive management. The authors are from the Universities of Wuerzburg (Germany) and Oulu (Finland).


Parameters:

(1) gender

(2) smoking status

(3) previous history of PONV or motion sickness

(4) postoperative opioid use

 

Parameter

Finding

Points

gender

male

0

 

female

1

smoking status

smoker

0

 

nonsmoker

1

history of PONV or motion sickness

absent

0

 

present

1

postoperative opioid use

no

0

 

yes

1

 

number of risk factors =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 4

• The higher the number of risk factors, the higher the PONV risk.

 

Number of Risk Factors

Risk of PONV

0 or 1

10 - 21%

2 or more

39-78%

 

Management of a person at risk for PONV may include:

(1) change in anesthetic technique to one less likely to cause PONV, such as use of intravenous anesthesia  with propofol

(2) administration of prophylactic antiemetic therapy

(3) change in analgesia to minimize the dose of postoperative opioids


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Specialty

Objective

ICD-10