Assessing the value of risk indices of postoperative nausea and vomiting in ambulatory surgical patients.

PURPOSE OF REVIEW: Postoperative and postdischarge nausea and vomiting have profound impact on the efficient delivery of quality healthcare. In addition to patient dissatisfaction, physical morbidities as well as unplanned hospital admissions may result. It is important to risk stratify and intervene on patients at risk. The aim of this review is to explore the benefits and shortcomings of the scoring systems commonly used today.

RECENT FINDINGS: Two widely-used risk stratification systems identify and score patient-, anesthesia-, and surgery-related risk factors for postoperative/postdischarge nausea and vomiting in the adult population. These systems have much overlap, with previous history of nausea and vomiting being the biggest risk factor. There is also a risk stratifying system for pediatric patients. Based on the preoperative score, a patient may be deemed low, intermediate, or high risk. Once stratified, appropriate medications and/or other interventions may be planned to prevent postoperative/postdischarge nausea and vomiting.

SUMMARY: Risk-stratifying scoring systems seek to identify patients at risk for postoperative/postdischarge nausea and vomiting. A protocol-based approach is recommended. A number of risk stratification systems have been validated and have been simplified for widespread adoption. Some institutions report a decrease in postoperative nausea and vomiting rates when an algorithm is followed based on one of the three scoring systems. By identifying at risk patients, an anesthetic can be better planned. A reduction in the incidence of postoperative/postdischarge nausea and vomiting will have a direct effect upon patient satisfaction, morbidity, and healthcare costs.