Does previous chemotherapy-induced nausea and vomiting predict postoperative nausea and vomiting?

Abstract

Background: Postoperative nausea and vomiting (PONV) remains a problem in the postoperative period. Previous PONV in oncology patients has recently been associated with chemotherapy-induced nausea and vomiting (CINV). We assessed if CINV could improve Apfel's heuristic for predicting PONV.

Methods: We conducted a retrospective study of 1500 consecutive patients undergoing intermediate or major cancer surgery between April and July 2011. PONV was assessed in the first postoperative day during post-anaesthesia care. The assigned anaesthetist completed an electronic medical record with all of the studied variables. Multiple logistic regression analyses were performed to assess whether any of the variables could add predictive ability to Apfel's tallying heuristic, and receiver operating characteristic (ROC) curves were modelled. The areas under the curve (AUC) were used to compare the model's discriminating ability for predicting patients who vomited from those who did not vomit.

Results: The overall incidence of PONV was 26%. Multiple logistic regressions identified two independent predictors for PONV (odds ratio; 95% CI), Apfel's score (1.78; 1.23-2.63) and previous chemotherapy-induced vomiting (3.15; 1.71-5.9), Hosmer-Lemeshow's P < 0.0001. Previous CINV was the most significant predictor to be added to Apfel's heuristic in this population.

Conclusions: A history of chemotherapy-induced nausea vomiting was a strong predictor for PONV and should be investigated as an added risk factor for PONV in the preoperative period of oncology surgery in prospective studies.