title: A risk adapted approach reduces the overall institutional incidence of postoperative nausea and vomiting.
abstract: OBJECTIVE
  Routine prophylactic antiemetic treatment of surgical patients appears justified only in case of an increased risk of postoperative nausea and vomiting (PONV). The objective of this investigation was to assess the feasibility and efficacy of a dichotomized risk score adapted management of PONV based on ondansetron prophylaxis and treatment with respect to the overall institutional rate of PONV.
  
  
  METHODS
  After estimating the individual PONV risk by a simplified score, 162 adult patients scheduled for elective surgery received either 4 mg ondansetron intravenously (two to four risk factors = high-risk) or no prophylaxis (zero to one risk factor = low-risk). For antiemetic treatment ondansetron was given intravenously and orally. Incidence of PONV was recorded during the first 24 hr after recovery.
  
  
  RESULTS
  Data from 159 subjects were analyzed with 44 patients classified as low-risk and 115 patients classified as high-risk. Nine low-risk and 58 high-risk patients experienced PONV. The expected institutional PONV incidence of 47% was reduced to 36%. Treatment with ondansetron was necessary in seven low-risk and 37 high-risk patients with a complete response rate of 71% (low-risk) and 43% (high-risk).
  
  
  CONCLUSIONS
  Providing antiemetic prophylaxis with ondansetron to high-risk patients strictly based on a simplified risk score can reduce the overall institutional rate of PONV. However, classifying patients into two groups while using ondansetron as the single antiemetic in the high-risk group appears to be of limited efficacy as the incidence of PONV in high-risk patients is still double that of low-risk patients.
authors.affiliation: Klinik für Anaesthesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg/Saar, Germany. anabie@med-rz.uni-sb.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Biedler
authors.forename: Julius
authors.initials: J
authors.lastname: Wermelt
authors.forename: Oliver
authors.initials: O
authors.lastname: Kunitz
authors.forename: Andrea
authors.initials: A
authors.lastname: Müller
authors.forename: Wolfram
authors.initials: W
authors.lastname: Wilhelm
authors.forename: Jürgen
authors.initials: J
authors.lastname: Dethling
authors.forename: Christian C
authors.initials: CC
authors.lastname: Apfel
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000769:Anesthesia, Inhalation; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D017294:Ondansetron / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology* / Q000517:prevention & control*; D018570:Risk Assessment
chemical_list: D000932:Antiemetics; D017294:Ondansetron