The impact of the Apfel scoring system for prophylaxis of post-operative nausea and vomiting: A randomized controlled trial
Background and Aims: Post-operative nausea and vomiting (PONV) is common, undesirable, and stressful following surgery. By focusing attention and resources on those groups of patients most likely to develop PONV, the quality of care provided to the patients can be improved. The primary objective was...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2023-01-01
|
| Series: | Journal of Anaesthesiology Clinical Pharmacology |
| Subjects: | |
| Online Access: | http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=3;spage=463;epage=467;aulast=Avinash |
| _version_ | 1797245310555127808 |
|---|---|
| author | Shastri H Avinash Handattu Mahabaleswara Krishna |
| author_facet | Shastri H Avinash Handattu Mahabaleswara Krishna |
| author_sort | Shastri H Avinash |
| collection | DOAJ |
| description | Background and Aims: Post-operative nausea and vomiting (PONV) is common, undesirable, and stressful following surgery. By focusing attention and resources on those groups of patients most likely to develop PONV, the quality of care provided to the patients can be improved. The primary objective was to compare the incidence of PONV after implementation of the Apfel scoring system with the control group receiving prophylaxis for every surgery. The secondary objective was to identify the effect on the patient's expenditure/savings with respect to management of PONV.
Material and Methods: This prospective randomized controlled double-blinded study enrolled 70 patients undergoing surgeries under general anesthesia. Patients were randomized to group A (control group – all received PONV prophylaxis) and group B (Apfel stratification performed for PONV prophylaxis). Based on the Apfel system, the risk of PONV was classified as the grades low, moderate, and high risk. Patients at moderate and high risk received PONV prophylaxis in group B. Patients were monitored for PONV during 24 h after surgery and rescue medication given as required. The effect of implementing Apfel risk stratification on the incidence of PONV (primary outcome measure) and on patient expenditure was compared.
Results: Compared to administering prophylaxis for all patients, the incidence of PONV [group A-5 patients (14.3%)] did not increase (P = 0.428) after implementing the Apfel scoring system [group B-2 patients (5.7%)]. The number of patients spending on prophylaxis for PONV in group A [35 (100%)] was higher than that in group B [17 (48%)], without increasing expenditure on PONV treatment.
Conclusion: Withholding prophylaxis on the basis of the Apfel scoring system did not increase the incidence of PONV compared to providing prophylaxis for all the patients. The overall cost of prevention and treatment of PONV is less when the Apfel scoring system is used. |
| first_indexed | 2024-03-11T15:42:47Z |
| format | Article |
| id | doaj.art-09afdd926e084f92ab97ed8fbc187df8 |
| institution | Directory Open Access Journal |
| issn | 0970-9185 |
| language | English |
| last_indexed | 2024-04-24T19:24:52Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Anaesthesiology Clinical Pharmacology |
| spelling | doaj.art-09afdd926e084f92ab97ed8fbc187df82024-03-25T15:51:29ZengWolters Kluwer Medknow PublicationsJournal of Anaesthesiology Clinical Pharmacology0970-91852023-01-0139346346710.4103/joacp.joacp_553_21The impact of the Apfel scoring system for prophylaxis of post-operative nausea and vomiting: A randomized controlled trialShastri H AvinashHandattu Mahabaleswara KrishnaBackground and Aims: Post-operative nausea and vomiting (PONV) is common, undesirable, and stressful following surgery. By focusing attention and resources on those groups of patients most likely to develop PONV, the quality of care provided to the patients can be improved. The primary objective was to compare the incidence of PONV after implementation of the Apfel scoring system with the control group receiving prophylaxis for every surgery. The secondary objective was to identify the effect on the patient's expenditure/savings with respect to management of PONV. Material and Methods: This prospective randomized controlled double-blinded study enrolled 70 patients undergoing surgeries under general anesthesia. Patients were randomized to group A (control group – all received PONV prophylaxis) and group B (Apfel stratification performed for PONV prophylaxis). Based on the Apfel system, the risk of PONV was classified as the grades low, moderate, and high risk. Patients at moderate and high risk received PONV prophylaxis in group B. Patients were monitored for PONV during 24 h after surgery and rescue medication given as required. The effect of implementing Apfel risk stratification on the incidence of PONV (primary outcome measure) and on patient expenditure was compared. Results: Compared to administering prophylaxis for all patients, the incidence of PONV [group A-5 patients (14.3%)] did not increase (P = 0.428) after implementing the Apfel scoring system [group B-2 patients (5.7%)]. The number of patients spending on prophylaxis for PONV in group A [35 (100%)] was higher than that in group B [17 (48%)], without increasing expenditure on PONV treatment. Conclusion: Withholding prophylaxis on the basis of the Apfel scoring system did not increase the incidence of PONV compared to providing prophylaxis for all the patients. The overall cost of prevention and treatment of PONV is less when the Apfel scoring system is used.http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=3;spage=463;epage=467;aulast=Avinashapfels' scoring systempost-operative nausea and vomitingprophylaxis for ponv |
| spellingShingle | Shastri H Avinash Handattu Mahabaleswara Krishna The impact of the Apfel scoring system for prophylaxis of post-operative nausea and vomiting: A randomized controlled trial Journal of Anaesthesiology Clinical Pharmacology apfels' scoring system post-operative nausea and vomiting prophylaxis for ponv |
| title | The impact of the Apfel scoring system for prophylaxis of post-operative nausea and vomiting: A randomized controlled trial |
| title_full | The impact of the Apfel scoring system for prophylaxis of post-operative nausea and vomiting: A randomized controlled trial |
| title_fullStr | The impact of the Apfel scoring system for prophylaxis of post-operative nausea and vomiting: A randomized controlled trial |
| title_full_unstemmed | The impact of the Apfel scoring system for prophylaxis of post-operative nausea and vomiting: A randomized controlled trial |
| title_short | The impact of the Apfel scoring system for prophylaxis of post-operative nausea and vomiting: A randomized controlled trial |
| title_sort | impact of the apfel scoring system for prophylaxis of post operative nausea and vomiting a randomized controlled trial |
| topic | apfels' scoring system post-operative nausea and vomiting prophylaxis for ponv |
| url | http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=3;spage=463;epage=467;aulast=Avinash |
| work_keys_str_mv | AT shastrihavinash theimpactoftheapfelscoringsystemforprophylaxisofpostoperativenauseaandvomitingarandomizedcontrolledtrial AT handattumahabaleswarakrishna theimpactoftheapfelscoringsystemforprophylaxisofpostoperativenauseaandvomitingarandomizedcontrolledtrial AT shastrihavinash impactoftheapfelscoringsystemforprophylaxisofpostoperativenauseaandvomitingarandomizedcontrolledtrial AT handattumahabaleswarakrishna impactoftheapfelscoringsystemforprophylaxisofpostoperativenauseaandvomitingarandomizedcontrolledtrial |