title: Applicability of risk scores for postoperative nausea and vomiting in a Taiwanese population undergoing general anaesthesia.
abstract: Five popular scoring systems for postoperative nausea and vomiting (PONV) were validated and compared with two new predictive models in a Taiwanese population. Nine hundred and ninety-two patients receiving general anaesthesia in a tertiary hospital were investigated in a prospective observational cohort study. Patient demographic data and the incidence of nausea or vomiting in the first 24 hours after surgery were recorded. The overall incidence of PONV was 42%. The area under the curve (AUC) of the five published PONV risk scoring systems was 0.62 to 0.67. Logistic regression analysis in this study cohort showed that female sex and a history of PONV/car sickness were the only statistically significant independent risk factors for PONV (likelihood ratio test P <0.001).The AUCs of our two-predictor and gender-only models were 0.668 and 0.643, respectively (Nagelkerke R² = 0.122 and 0.109). Goodness-of-fit showed that a two-predictor model predicted outcome that was in agreement with the observed outcome (P=0.973). Both the two-predictor model and the Apfel score had a similar AUC that was significantly different from the AUCs of the other models. The AUC for the gender-only model in our population was similar to that of the simplified Koivuranta and the Palazzo and Evans scores (AUC=0.659 and 0.632; P=0.137 and 0.513 respectively). All AUCs had only moderate discrimination power but our female gender-only model was much simpler. Using female gender as the only predictor of PONV had predictive power with 75% sensitivity and 54% specificity.
authors.affiliation: Department of Anesthesiology, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: Y H
authors.initials: YH
authors.lastname: Wu
authors.affiliation: Director, Institute of Molecular Medicine, Center for Genomic Medicine, National Cheng Kung University and Medical College, Tainan, Taiwan.
authors.forename: H S
authors.initials: HS
authors.lastname: Sun
authors.affiliation: Professor, Institute of Gerontology, National Cheng Kung University and Medical College, Tainan, Taiwan.
authors.forename: S T
authors.initials: ST
authors.lastname: Wang
authors.affiliation: Associate Professor and Chairman, Department of Anesthesiology, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: C C
authors.initials: CC
authors.lastname: Tseng
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects*; D019540:Area Under Curve; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D013624:Taiwan
keywords: Apfel score; Koivuranta score; car sickness; postoperative nausea and vomiting