A risk score for postoperative nausea and/or vomiting in women undergoing cesarean delivery with intrathecal morphine |
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Institution: | 1. Department of Anesthesiology, Division of Women’s Anesthesia, Duke University Medical Center, Durham, NC, USA;2. Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA;1. Anesthesiology Department, “Alexandra” General Hospital of Athens, Greece;2. 1st Departement of Obstetrics & Gynecology, University of Athens Medical School, “Alexandra” General Hospital of Athens, Greece;1. Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand;2. Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand;3. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA;1. Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan;2. Division of Anesthesia, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan;3. Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan;1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA;2. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA;3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA |
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Abstract: | BackgroundPostoperative nausea and/or vomiting affects up to 80% of parturients undergoing cesarean delivery, but there is a lack of obstetric-specific risk-prediction models. We performed this study to identify postoperative nausea/vomiting risk factors in parturients undergoing cesarean delivery, formulate an obstetric-specific prediction model (Duke score), and compare its performance against the Apfel score.MethodsA post-hoc analysis of data from two randomized controlled trials studying nausea/vomiting in women undergoing cesarean delivery with intrathecal morphine. Potential risk factors for postoperative nausea/vomiting within 24 h of surgery with univariate associations with P ≤0.20 were considered for inclusion in the multivariable analysis. After identifying the final multivariable model, we derived our Duke score by assigning points to the selected factors. We then tested the association of the Duke and Apfel scores with postoperative nausea and vomiting, and compared the area-under-the-receiver operating characteristic curve.ResultsAnalysis included 260 parturients, of whom 146 (56.2%) experienced postoperative nausea/vomiting. Non-smoking during pregnancy (OR 2.29 95% CI 1.12 to 4.67], P=0.023), and history of postoperative nausea/vomiting after cesarean delivery and/or morning sickness (2.09 1.12 to 3.91], P=0.021) were independent predictors of postoperative nausea/vomiting and included in the Duke score. Both Duke and Apfel scores trended linearly with postoperative nausea/vomiting risk (Duke P=0.001; Apfel P=0.049) and had comparable areas-under-the-receiver operating characteristic curve (Duke 0.63 0.57 to 0.70]; Apfel 0.59 0.52 to 0.65], P=0.155).ConclusionsBoth Duke and Apfel scores exhibited similar but poor predictive performance. Until better tools are developed, routine prophylactic anti-emetics appears to be a reasonable approach in this patient population. |
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Keywords: | Apfel score Cesarean delivery Intrathecal opioids Neuraxial anesthesia Postoperative nausea/vomiting |
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