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A risk score for postoperative nausea and/or vomiting in women undergoing cesarean delivery with intrathecal morphine.

Publication ,  Journal Article
Tan, HS; Cooter, M; George, RB; Habib, AS
Published in: Int J Obstet Anesth
November 2020

BACKGROUND: Postoperative 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. METHODS: A 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. RESULTS: Analysis 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). CONCLUSIONS: Both 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.

Duke Scholars

Published In

Int J Obstet Anesth

DOI

EISSN

1532-3374

Publication Date

November 2020

Volume

44

Start / End Page

126 / 130

Location

Netherlands

Related Subject Headings

  • Risk Assessment
  • Pregnancy
  • Postoperative Nausea and Vomiting
  • Morphine
  • Injections, Spinal
  • Humans
  • Female
  • Cesarean Section
  • Anesthesiology
  • Analgesics, Opioid
 

Citation

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Tan, H. S., Cooter, M., George, R. B., & Habib, A. S. (2020). A risk score for postoperative nausea and/or vomiting in women undergoing cesarean delivery with intrathecal morphine. Int J Obstet Anesth, 44, 126–130. https://doi.org/10.1016/j.ijoa.2020.08.008
Tan, H. S., M. Cooter, R. B. George, and A. S. Habib. “A risk score for postoperative nausea and/or vomiting in women undergoing cesarean delivery with intrathecal morphine.Int J Obstet Anesth 44 (November 2020): 126–30. https://doi.org/10.1016/j.ijoa.2020.08.008.
Tan HS, Cooter M, George RB, Habib AS. A risk score for postoperative nausea and/or vomiting in women undergoing cesarean delivery with intrathecal morphine. Int J Obstet Anesth. 2020 Nov;44:126–30.
Tan, H. S., et al. “A risk score for postoperative nausea and/or vomiting in women undergoing cesarean delivery with intrathecal morphine.Int J Obstet Anesth, vol. 44, Nov. 2020, pp. 126–30. Pubmed, doi:10.1016/j.ijoa.2020.08.008.
Tan HS, Cooter M, George RB, Habib AS. A risk score for postoperative nausea and/or vomiting in women undergoing cesarean delivery with intrathecal morphine. Int J Obstet Anesth. 2020 Nov;44:126–130.
Journal cover image

Published In

Int J Obstet Anesth

DOI

EISSN

1532-3374

Publication Date

November 2020

Volume

44

Start / End Page

126 / 130

Location

Netherlands

Related Subject Headings

  • Risk Assessment
  • Pregnancy
  • Postoperative Nausea and Vomiting
  • Morphine
  • Injections, Spinal
  • Humans
  • Female
  • Cesarean Section
  • Anesthesiology
  • Analgesics, Opioid