title: Who is at risk for postdischarge nausea and vomiting after ambulatory surgery?
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.
authors: Epidemiology and Biostatistics, Mt. Zion Medical Center, San Francisco General Hospital, Department of Anesthesia & Perioperative Care, University of California San Francisco, San Francisco, California 94115, USA. apfelc@anesthesia.ucsf.edu
authors: Christian C
authors: CC
authors: Apfel
authors: Beverly K
authors: BK
authors: Philip
authors: Ozlem S
authors: OS
authors: Cakmakkaya
authors: Ashley
authors: A
authors: Shilling
authors: Yun-Ying
authors: YY
authors: Shi
authors: John B
authors: JB
authors: Leslie
authors: Martin
authors: M
authors: Allard
authors: Alparslan
authors: A
authors: Turan
authors: Pamela
authors: P
authors: Windle
authors: Jan
authors: J
authors: Odom-Forren
authors: Vallire D
authors: VD
authors: Hooper
authors: Oliver C
authors: OC
authors: Radke
authors: Joseph
authors: J
authors: Ruiz
authors: Anthony
authors: A
authors: Kovac
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000932:Antiemetics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D020250:Postoperative Nausea and Vomiting / Q000209:etiology*; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D000932:Antiemetics