Abstract
Purpose
To compare two of the latest published scores for predicting postoperative nausea and vomiting (PONV) in potentially high-risk patients.
Methods
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.
Results
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 Sinclair-score was y = 1.08x − 0.07 and y = 0.93x + 0.27.
Conclusion
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.
Résumé
Objectif
Comparer deux des dernières cotations publiées servant à prédire l’incidence de nausées et de vomissements postopératoires (NVPO) chez des sujets virtuellement à haut risque.
Méthodes
Des patients adultes, hospitalisés pour une intervention chirurgicale pharyngée, thyroïdienne, gynécologique ou du sein, sous anesthésie générale par inhalation, ont participé à l’étude prospective de 24 h sur les NVPO. Les demières cotations publiées considèrent quatre facteurs de risque : être de sexe féminin, avoir des antécédents de NVPO ou de mal des transports, être non-fumeur et utiliser des o-pioïdes postopératoires (cotation d’Apfel). Les cotations publiées antérieurement y ajoutent la durée, le type d’anesthésie et de chirurgie (cotation de Sinclair). Les deux cotations ont été comparées en calculant l’aire sous la courbe d’analyse ROC et les courbes d’é-talonnage du tracé de l’incidence prédite et observée de NVPO.
Résultats
Cinq cents patients successifs ont été étudiés. Ceux qui ont reçu des antiémétiques prophylactiques ont été exclus. Des 428 patients restants, 49,5 % ont eu des NVPO. L’analyse multivariée a révélé que l’âge, le sexe, les antécédents de NVPO ou la maladie des transports et l’usage postopératoire d’opioïdes agissent sur les NVPO. L’aire sous la courbe ROC a été significativement plus grande pour la cotation d’Apfel, comparée à la cotation de Sinclair (0,71 vs 0,64, P = 0,008). La corrélation entre l’incidence prévue (x) et observée (y) a été pour la cotation d’Apfel et pour la cotation de Sinclair y = 1,08 x − 0,07 et y = 0,93 x + 0,27.
Conclusion
La cotation d’Apfel simplifiée a présenté des propriétés discriminantes favorables et des qualités d’étalonnage utiles à la prédiction du risque de NVPO. Nous l’avons donc intégrée à notre pratique clinique quotidienne ainsi qu’à un essai antiémétique en cours.
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Pierre, S., Benais, H. & Pouymayou, J. Apfel’s simplified score may favourably predict the risk of postoperative nausea and vomiting. Can J Anesth 49, 237–242 (2002). https://doi.org/10.1007/BF03020521
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DOI: https://doi.org/10.1007/BF03020521