Background Postoperative nausea and vomiting (PONV) is nowadays the most common adverse effect of anesthesia with an incidence of 30% in a general postsurgical population. According to studies, most patients concerned appraise PONV as even more undesirable than postoperative pain. The avoidance of PONV through a valid and structured preoperative risk evaluation and a suitable PONV prophylaxis is part of a quality standard of modern anesthetic regimens. In our department of anesthesiology and intensive care medicine, a new standard operating procedure (SOP) for the preoperative estimation of the risk of PONV according to the Apfel score and to the structured prophylaxis and treatment was implemented in September 2022. Objective 1. To what extent is the SOP applied in the daily clinical routine? 2. What impact does the implementation of a new SOP have on the incidence of PONV in a population of patients under PONV prophylaxis as compared to a treatment which was noncompliant to the SOP? Methods In this study 2000 retrospective anesthesia data of patients who underwent a routinely scheduled elective surgery under full anesthesia in the departments of otorhinolaryngology, ophthalmology, gynecology, urology, neurosurgery, orthopedic surgery and visceral surgery were analyzed regarding the preoperative evaluation for risk factors, the intraoperative use of prophylactic agents and the incidence of PONV in the postanesthesia care unit as well as at the surgical ward up to 24 h postoperatively. Results Data of 1880 adult patients and 120 pediatric patients aged 14 years and younger were examined. All in all, the adherence to the new PONV SOP was 46.3%. The chance for a prophylaxis concurrent with the SOP was increased by notification of the preoperative Apfel score as well as by mentioning the indicated PONV prophylaxis in the preoperatively scheduled anesthesia regimen. Prophylaxis and treatment according to the new PONV SOP led to a decrease in the relative PONV risk by 29% as well as in the need for antiemetic rescue medication by 26% in adult patients. The PONV incidence was significantly reduced postoperatively in the surgical ward (p = 0.048) and in the high-risk patient population with an Apfel score of three or four PONV risk factors (p < 0.001). In addition, the need for antiemetic rescue medication 24 h postoperatively significantly decreased in the high-risk group (p = 0.008). In the small population of pediatric patients the recommendation of preoperative evaluation for PONV risk was translated into practice in 7.5%. Conclusion A structured SOP regarding the prophylaxis of PONV is a suitable measure to reduce the incidence of PONV and the postoperative need of antiemetic rescue agents, especially in high-risk populations. Nevertheless, further actions have to be taken to increase the adherence to SOPs and to ensure a sufficient coverage of prophylactic medication in vulnerable patient groups. According to our data, more attention needs to be directed to the issue of PONV risk and prophylaxis, particularly in pediatric patients.

Vorteile einer standardisierten PONV-Prophylaxe

期刊论文
发表日期：

2026年1月30日

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Maike Stegen,
Celine Nowak,
Thorsten Brenner,
Stefanie Klenke

摘要

Background

Postoperative nausea and vomiting (PONV) is nowadays the most common adverse effect of anesthesia with an incidence of 30% in a general postsurgical population. According to studies, most patients concerned appraise PONV as even more undesirable than postoperative pain. The avoidance of PONV through a valid and structured preoperative risk evaluation and a suitable PONV prophylaxis is part of a quality standard of modern anesthetic regimens. In our department of anesthesiology and intensive care medicine, a new standard operating procedure (SOP) for the preoperative estimation of the risk of PONV according to the Apfel score and to the structured prophylaxis and treatment was implemented in September 2022.

Objective

1. To what extent is the SOP applied in the daily clinical routine? 2. What impact does the implementation of a new SOP have on the incidence of PONV in a population of patients under PONV prophylaxis as compared to a treatment which was noncompliant to the SOP?

Methods

In this study 2000 retrospective anesthesia data of patients who underwent a routinely scheduled elective surgery under full anesthesia in the departments of otorhinolaryngology, ophthalmology, gynecology, urology, neurosurgery, orthopedic surgery and visceral surgery were analyzed regarding the preoperative evaluation for risk factors, the intraoperative use of prophylactic agents and the incidence of PONV in the postanesthesia care unit as well as at the surgical ward up to 24 h postoperatively.

Results

Data of 1880 adult patients and 120 pediatric patients aged 14 years and younger were examined. All in all, the adherence to the new PONV SOP was 46.3%. The chance for a prophylaxis concurrent with the SOP was increased by notification of the preoperative Apfel score as well as by mentioning the indicated PONV prophylaxis in the preoperatively scheduled anesthesia regimen. Prophylaxis and treatment according to the new PONV SOP led to a decrease in the relative PONV risk by 29% as well as in the need for antiemetic rescue medication by 26% in adult patients. The PONV incidence was significantly reduced postoperatively in the surgical ward (p = 0.048) and in the high-risk patient population with an Apfel score of three or four PONV risk factors (p < 0.001). In addition, the need for antiemetic rescue medication 24 h postoperatively significantly decreased in the high-risk group (p = 0.008). In the small population of pediatric patients the recommendation of preoperative evaluation for PONV risk was translated into practice in 7.5%.

Conclusion

A structured SOP regarding the prophylaxis of PONV is a suitable measure to reduce the incidence of PONV and the postoperative need of antiemetic rescue agents, especially in high-risk populations. Nevertheless, further actions have to be taken to increase the adherence to SOPs and to ensure a sufficient coverage of prophylactic medication in vulnerable patient groups. According to our data, more attention needs to be directed to the issue of PONV risk and prophylaxis, particularly in pediatric patients.