Does an educational strategy based on systematic preoperative assessment of simplified Apfel's score decrease postoperative nausea and vomiting?

BACKGROUND AND

OBJECTIVE

Postoperative nausea and vomiting (PONV) is a frequent and unpleasant side effect occurring after anaesthesia and surgery. In the present study, we hypothesized that an educational strategy based on systematic preoperative assessment of the simplified Apfel's score decreased the incidence of PONV in a population of adult surgical patients.

METHODS

All consecutive patients admitted in the postanaesthesia care unit (PACU) for elective surgery under general anaesthesia were included and PONV occurring in the PACU recorded. An educational strategy consisting in printing the items allowing calculation of the simplified Apfel's score on the records of the preanaesthetic visit, and encouraging anaesthetists to measure and record it was set up. Meetings dedicated to PONV prevention by emphasis on the current guidelines were regularly organized. The primary endpoint was the incidence of PONV occurring in the PACU.

RESULTS

One hundred and ninety-one patients were included during the control period (08/01/07 to 28/02/07) and 193 after the educational strategy (01/03/07 to 30/04/07). The incidence of PONV was decreased in the second period from 19.37% to 11.4% (p=0.0340). The rate of administration of intraoperative prophylactic anti-emetics in high-risk groups increased from 36.4% to 52.8% (p=0.049). The prescription rate of anti-emetic prophylaxis correlated with the PONV risk derived from the simplified Apfel's score in the second period of the study (p=0.1415 before, vs. p=0.0005 after).

CONCLUSION

An educational strategy based on systematic preoperative measurement and recording of the simplified Apfel's score is efficient to decrease markedly the incidence of PONV in a population of adult surgical patients.