Who is at risk for postdischarge nausea and vomiting after ambulatory surgery?

Christian C. Apfel, Beverly K. Philip, Ozlem S. Cakmakkaya, Ashley Shilling, Yun Ying Shi, John B. Leslie, Martin Allard, Alparslan Turan, Pamela Windle, Jan Odom-Forren, Vallire D. Hooper, Oliver C. Radke, Joseph Ruiz, Anthony Kovac

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

BACKGROUND:: About one in four patients suffers from postoperative nausea and vomiting. Fortunately, risk scores have been developed to better manage this outcome in hospitalized patients, but there is currently no risk score for postdischarge nausea and vomiting (PDNV) in ambulatory surgical patients. METHODS:: We conducted a prospective multicenter study of 2,170 adults undergoing general anesthesia at ambulatory surgery centers in the United States from 2007 to 2008. PDNV was assessed from discharge until the end of the second postoperative day. Logistic regression analysis was applied to a development dataset and the area under the receiver operating characteristic curve was calculated in a validation dataset. RESULTS:: The overall incidence of PDNV was 37%. Logistic regression analysis of the development dataset (n = 1,913) identified five independent predictors (odds ratio; 95% CI): female gender (1.54; 1.22 to 1.94), age less than 50 yr (2.17; 1.75 to 2.69), history of nausea and/or vomiting after previous anesthesia (1.50; 1.19 to 1.88), opioid administration in the postanesthesia care unit (1.93; 1.53 to 2.43), and nausea in the postanesthesia care unit (3.14; 2.44-4.04). In the validation dataset (n = 257), zero, one, two, three, four, and five of these factors were associated with a PDNV incidence of 7%, 20%, 28%, 53%, 60%, and 89%, respectively, and an area under the receiver operating characteristic curve of 0.72 (0.69 to 0.73). CONCLUSIONS:: PDNV affects a substantial number of patients after ambulatory surgery. We developed and validated a simplified risk score to identify patients who would benefit from long-acting prophylactic antiemetics at discharge from the ambulatory care center.

Original languageEnglish (US)
Pages (from-to)475-486
Number of pages12
JournalAnesthesiology
Volume117
Issue number3
DOIs
StatePublished - Sep 2012

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Ambulatory Surgical Procedures
Nausea
Vomiting
ROC Curve
Logistic Models
Regression Analysis
Postoperative Nausea and Vomiting
Antiemetics
Incidence
Ambulatory Care
General Anesthesia
Opioid Analgesics
Multicenter Studies
Anesthesia
Odds Ratio
Prospective Studies
Datasets

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Apfel, C. C., Philip, B. K., Cakmakkaya, O. S., Shilling, A., Shi, Y. Y., Leslie, J. B., ... Kovac, A. (2012). Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology, 117(3), 475-486. https://doi.org/10.1097/ALN.0b013e318267ef31

Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? / Apfel, Christian C.; Philip, Beverly K.; Cakmakkaya, Ozlem S.; Shilling, Ashley; Shi, Yun Ying; Leslie, John B.; Allard, Martin; Turan, Alparslan; Windle, Pamela; Odom-Forren, Jan; Hooper, Vallire D.; Radke, Oliver C.; Ruiz, Joseph; Kovac, Anthony.

In: Anesthesiology, Vol. 117, No. 3, 09.2012, p. 475-486.

Research output: Contribution to journalArticle

Apfel, CC, Philip, BK, Cakmakkaya, OS, Shilling, A, Shi, YY, Leslie, JB, Allard, M, Turan, A, Windle, P, Odom-Forren, J, Hooper, VD, Radke, OC, Ruiz, J & Kovac, A 2012, 'Who is at risk for postdischarge nausea and vomiting after ambulatory surgery?', Anesthesiology, vol. 117, no. 3, pp. 475-486. https://doi.org/10.1097/ALN.0b013e318267ef31
Apfel CC, Philip BK, Cakmakkaya OS, Shilling A, Shi YY, Leslie JB et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology. 2012 Sep;117(3):475-486. https://doi.org/10.1097/ALN.0b013e318267ef31
Apfel, Christian C. ; Philip, Beverly K. ; Cakmakkaya, Ozlem S. ; Shilling, Ashley ; Shi, Yun Ying ; Leslie, John B. ; Allard, Martin ; Turan, Alparslan ; Windle, Pamela ; Odom-Forren, Jan ; Hooper, Vallire D. ; Radke, Oliver C. ; Ruiz, Joseph ; Kovac, Anthony. / Who is at risk for postdischarge nausea and vomiting after ambulatory surgery?. In: Anesthesiology. 2012 ; Vol. 117, No. 3. pp. 475-486.
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abstract = "BACKGROUND:: About one in four patients suffers from postoperative nausea and vomiting. Fortunately, risk scores have been developed to better manage this outcome in hospitalized patients, but there is currently no risk score for postdischarge nausea and vomiting (PDNV) in ambulatory surgical patients. METHODS:: We conducted a prospective multicenter study of 2,170 adults undergoing general anesthesia at ambulatory surgery centers in the United States from 2007 to 2008. PDNV was assessed from discharge until the end of the second postoperative day. Logistic regression analysis was applied to a development dataset and the area under the receiver operating characteristic curve was calculated in a validation dataset. RESULTS:: The overall incidence of PDNV was 37{\%}. Logistic regression analysis of the development dataset (n = 1,913) identified five independent predictors (odds ratio; 95{\%} CI): female gender (1.54; 1.22 to 1.94), age less than 50 yr (2.17; 1.75 to 2.69), history of nausea and/or vomiting after previous anesthesia (1.50; 1.19 to 1.88), opioid administration in the postanesthesia care unit (1.93; 1.53 to 2.43), and nausea in the postanesthesia care unit (3.14; 2.44-4.04). In the validation dataset (n = 257), zero, one, two, three, four, and five of these factors were associated with a PDNV incidence of 7{\%}, 20{\%}, 28{\%}, 53{\%}, 60{\%}, and 89{\%}, respectively, and an area under the receiver operating characteristic curve of 0.72 (0.69 to 0.73). CONCLUSIONS:: PDNV affects a substantial number of patients after ambulatory surgery. We developed and validated a simplified risk score to identify patients who would benefit from long-acting prophylactic antiemetics at discharge from the ambulatory care center.",
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AU - Apfel, Christian C.

AU - Philip, Beverly K.

AU - Cakmakkaya, Ozlem S.

AU - Shilling, Ashley

AU - Shi, Yun Ying

AU - Leslie, John B.

AU - Allard, Martin

AU - Turan, Alparslan

AU - Windle, Pamela

AU - Odom-Forren, Jan

AU - Hooper, Vallire D.

AU - Radke, Oliver C.

AU - Ruiz, Joseph

AU - Kovac, Anthony

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N2 - BACKGROUND:: About one in four patients suffers from postoperative nausea and vomiting. Fortunately, risk scores have been developed to better manage this outcome in hospitalized patients, but there is currently no risk score for postdischarge nausea and vomiting (PDNV) in ambulatory surgical patients. METHODS:: We conducted a prospective multicenter study of 2,170 adults undergoing general anesthesia at ambulatory surgery centers in the United States from 2007 to 2008. PDNV was assessed from discharge until the end of the second postoperative day. Logistic regression analysis was applied to a development dataset and the area under the receiver operating characteristic curve was calculated in a validation dataset. RESULTS:: The overall incidence of PDNV was 37%. Logistic regression analysis of the development dataset (n = 1,913) identified five independent predictors (odds ratio; 95% CI): female gender (1.54; 1.22 to 1.94), age less than 50 yr (2.17; 1.75 to 2.69), history of nausea and/or vomiting after previous anesthesia (1.50; 1.19 to 1.88), opioid administration in the postanesthesia care unit (1.93; 1.53 to 2.43), and nausea in the postanesthesia care unit (3.14; 2.44-4.04). In the validation dataset (n = 257), zero, one, two, three, four, and five of these factors were associated with a PDNV incidence of 7%, 20%, 28%, 53%, 60%, and 89%, respectively, and an area under the receiver operating characteristic curve of 0.72 (0.69 to 0.73). CONCLUSIONS:: PDNV affects a substantial number of patients after ambulatory surgery. We developed and validated a simplified risk score to identify patients who would benefit from long-acting prophylactic antiemetics at discharge from the ambulatory care center.

AB - BACKGROUND:: About one in four patients suffers from postoperative nausea and vomiting. Fortunately, risk scores have been developed to better manage this outcome in hospitalized patients, but there is currently no risk score for postdischarge nausea and vomiting (PDNV) in ambulatory surgical patients. METHODS:: We conducted a prospective multicenter study of 2,170 adults undergoing general anesthesia at ambulatory surgery centers in the United States from 2007 to 2008. PDNV was assessed from discharge until the end of the second postoperative day. Logistic regression analysis was applied to a development dataset and the area under the receiver operating characteristic curve was calculated in a validation dataset. RESULTS:: The overall incidence of PDNV was 37%. Logistic regression analysis of the development dataset (n = 1,913) identified five independent predictors (odds ratio; 95% CI): female gender (1.54; 1.22 to 1.94), age less than 50 yr (2.17; 1.75 to 2.69), history of nausea and/or vomiting after previous anesthesia (1.50; 1.19 to 1.88), opioid administration in the postanesthesia care unit (1.93; 1.53 to 2.43), and nausea in the postanesthesia care unit (3.14; 2.44-4.04). In the validation dataset (n = 257), zero, one, two, three, four, and five of these factors were associated with a PDNV incidence of 7%, 20%, 28%, 53%, 60%, and 89%, respectively, and an area under the receiver operating characteristic curve of 0.72 (0.69 to 0.73). CONCLUSIONS:: PDNV affects a substantial number of patients after ambulatory surgery. We developed and validated a simplified risk score to identify patients who would benefit from long-acting prophylactic antiemetics at discharge from the ambulatory care center.

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