Postoperative Nausea and Vomiting (PONV) Risk Assessment
The Apfel Score
A scoring system for assessing the risk of PONV risk in adults.
One point for each risk factors:
One point for each risk factors:
- Female gender
- Non-Smoker
- Previous PONV
- Postoperative Opioid Use
The risk of PONV, depending on the score is as follows:
0 - 10%
1 - 20%
2 - 40%
3 - 60%
4 - 80%
0 - 10%
1 - 20%
2 - 40%
3 - 60%
4 - 80%
Apfel Score for Post Discharge Nausea and Vomiting
A scoring system for assessing the risk of postdischarge nausea and vomiting (PDNV) risk in adults undergoing day-case surgery.
One point for each risk factors:
One point for each risk factors:
- Female Gender
- Previous PONV
- Age < 50 years
- Use of opioids in the post anaesthetic care unit (PACU)
- Nausea in the PACU
The risk of PDNV, depending on the score approximates to:
0 - 10%
1 - 20%
2 - 30%
3 - 50%
4 - 60%
5 - 80%
0 - 10%
1 - 20%
2 - 30%
3 - 50%
4 - 60%
5 - 80%
Paediatric PONV Risk Scoring (Eberhart)
A scoring system for assessing the risk of PONV risk in children
One point is allocated for each of the following:
One point is allocated for each of the following:
- Surgery > 30 mins
- Age greater or equal to 3 years
- Strabismus Surgery
- History of POV or PONV in relatives
The risk of postoperative vomiting (POV), depending on the total score approximates to:
0 - 9%
1 - 10%
2 - 30%
3 - 55%
4 - 70%
0 - 9%
1 - 10%
2 - 30%
3 - 55%
4 - 70%
The Koivuranta Score
A scoring system for assessing the risk of PONV risk in adults.
One point for each risk factors:
One point for each risk factors:
- Female Gender
- Non Smoker
- Previous PONV
- History of Motion Sickness
- Surgery > 60 mins
Other Risk Factors
As well as those covered in the above scoring systems, some other risk factors are important to know about.
These can be categorised into 'Patient', 'Surgical', and 'Anaesthetic' related factors.
Here, their magnitude is described in terms of an odds ratio (OR) alongside their 95% confidence intervals (CI).
These can be categorised into 'Patient', 'Surgical', and 'Anaesthetic' related factors.
Here, their magnitude is described in terms of an odds ratio (OR) alongside their 95% confidence intervals (CI).
Patient Factors:
Surgical Factors:
Anaesthetic Factors:
- Age under 50 (OR 1.79, CI 1.39 - 2.30)
- Age per decade (OR 0.88, CI 0.84 - 0.92)
- Female gender (OR 2.57, CI 2.32 - 2.84)
- History of PONV (OR 2.09, CI 1.90 - 2.29)
- Non smoker (OR 1.82, CI 1.68 - 1.98)
- History of motion sickness (1.77, CI 1.55 - 2.04)
Surgical Factors:
- Cholecystectomy (OR 1.90, CI 1.36 - 2.68)
- Gynaecological surgery (OR 1.24, CI 1.02 - 1.52)
- Laparoscopic surgery (OR 1.37, CI 1.07 - 1.77)
Anaesthetic Factors:
- Use of volatile anaesthetic agent (OR 1.82, CI 1.56 - 2.13)
- Duration of anaesthetic (OR 1.46 h-1, CI 1.30 - 1.63)
- Postoperative opioid use (OR 1.47, CI 1.31 - 1.65) - irrespective of type of drug in dose dependent manner
- Nitrous oxide use (OR 1.45, CI 1.06 - 1.98)
References:
- Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. T.J. Gan et al. Anesthesia & Analgesia. 2014. 118:85-113
- Who is at Risk for Postdischarge Nausea and Vomiting After Ambulatory Surgery? C.C. Apfel et al. Anesthesiology. 2012. 117(3):475-86
- The Development and Validation of a Risk Score to Predict the Probability of Postoperative Vomiting in Pediatric Patients. L.H.J. Eberhart et al. Anesthesia & Analgesia. 2004. 99(6):1630-7
