A risk score-dependent antiemetic approach effectively reduces postoperative nausea and vomiting — a continuous quality improvement initiative

PurposeIn a previous survey, patients at risk for postoperative nausea and vomiting (PONV) were best identified by a simplified risk score. Consequently we investigated whether a risk scoredependent antiemetic strategy could effectively reduce the incidence of PONV in our department.MethodsAdult in-patients (n = 428) scheduled for throat, thyroid, breast or gynecological surgery under general anesthesia were prospectively classified in three risk groups (L = low, M = medium, H = high) by using a simplified risk score. Patients in the L group did not receive any antiemetic prophylaxis. Patients in the M group received volatile anesthesia with 0.625 mg droperidol or an iv propofol anesthesia without droperidol. Patients in the H group received iv anesthesia supplemented with 4 mg dexamethasone and 0.625 mg droperidol.ResultsCompared with the data from our previous survey, the overall incidence of PONV decreased from 49.5% to 14.3% (P < 0.001). The incidence decreased from 34% to 13.2% (P < 0.001) in the M group and from 64.3% to 15.5% (P < 0.001) in the H group. Mean postanesthesia care unit time decreased from 99 to 82 min (P < 0.04).ConclusionThis is the first survey which suggests that the departmental incidence of PONV can be significantly lowered by a risk score-dependent antiemetic strategy through a quality improvement initiative.RésuméObjectifLors d’une enquête antérieure, des patients à risque d’avoir des nausées et des vomissements postopératoires (NVPO) ont été recensés par un score de risque simplifié. De là, nous voulions savoir si un traitement antiémétique relié au score de risque pouvait efficacement réduire l’incidence de NVPO.MéthodeDes aduites hospitaiisés (n = 428) pour une intervention chirurgicale pharyngienne, thyroïdienne, mammaire ou gynécoiogique sous anesthésie généraie ont été répartis de façon prospective en trois groupes de risque (F = faible, M = modéré, E = élevé) en utilisant un score de risque simplifié. Les patients du groupe F n’ont pas reçu de traitement antiémétique préventif. Ceux du groupe M ont reçu un anesthésique volatil avec 0,625 mg de dropéridol ou une anesthésie iv au propofol sans dropéridol. Ceux du groupe E ont reçu une anesthésie iv complétée par 4 mg de dexaméthasone et 0,625 mg de dropéridol.RésultatsComparés aux données obtenues de l’enquête, l’incidence totale de NVPO a chuté, passant de 49,5 %à 14,3 % (P < 0,001).Lincidence a baissé de 34 % à 13,2 % (P < 0,001) dans le groupe M et de 64,3 %à 15,5%(P < 0,001) dans le groupe E. Le séjour moyen en salle de réveil a diminué de 99 à 82 min (P < 0,04).ConclusionC’est la première enquête qui montre que l’incidence de NVPO dans notre service peut être signifcativement réduite par un traitement relié au score de risque.

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