title: A risk score-dependent antiemetic approach effectively reduces postoperative nausea and vomiting--a continuous quality improvement initiative.
abstract: OBJECTIVE
  In a previous survey, patients at risk for postoperative nausea and vomiting (PONV) were best identified by a simplified risk score. Consequently, we investigated whether a risk score-dependent antiemetic strategy could effectively reduce the incidence of PONV in our department.
  
  
  METHODS
  Adult in-patients (n = 428) scheduled for throat, thyroid, breast or gynecological surgery under general anesthesia were prospectively classified in three risk groups (L = low, M = medium, H = high) by using a simplified risk score. Patients in the L group did not receive any antiemetic prophylaxis. Patients in the M group received volatile anesthesia with 0.625 mg droperidol or an iv propofol anesthesia without droperidol. Patients in the H group received iv anesthesia supplemented with 4 mg dexamethasone and 0.625 mg droperidol.
  
  
  RESULTS
  Compared with the data from our previous survey, the overall incidence of PONV decreased from 49.5% to 14.3% (P < 0.001). The incidence decreased from 34% to 13.2% (P < 0.001) in the M group and from 64.3% to 15.5% (P < 0.001) in the H group. Mean postanesthesia care unit time decreased from 99 to 82 min (P < 0.04).
  
  
  CONCLUSIONS
  This is the first survey which suggests that the departmental incidence of PONV can be significantly lowered by a risk score-dependent antiemetic strategy through a quality improvement initiative.
authors.affiliation: Department of Anesthesiology, Institut Claudius Regaud, Toulouse, France. pierre@icr.jnclcc.fr
authors.forename: Sébastien
authors.initials: S
authors.lastname: Pierre
authors.forename: Gaelle
authors.initials: G
authors.lastname: Corno
authors.forename: Hervé
authors.initials: H
authors.lastname: Benais
authors.forename: Christian C
authors.initials: CC
authors.lastname: Apfel
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use; D004329:Droperidol / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology* / Q000517:prevention & control*; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D017749:Total Quality Management / Q000379:methods*
chemical_list: D000932:Antiemetics; D003907:Dexamethasone; D004329:Droperidol