Background: Postoperative nausea and vomiting (PONV) is a common complication following surgery. Only a few risk factors have consistently been reported to be independent predictors for PONV. Aim: To report Apfel scores for orthopedic patients then correlate these scores to the number of antiemetics prescribed and subsequently administered in both the perioperative and post operative setting and determine if screening for Apfel scores is beneficial to predict PONV. Methods: A retrospective analysis of patients admitted under orthopedic units between 1st July 2020 and 31st July 2020 was conducted at a tertiary teaching hospital in Australia. Patients were screened and allocated an Apfel score and antiemetics agents prescribed and subsequently administered were recorded. Results: A total of 115 patients were screened for inclusion. Of these 4 patients met this exclusion criteria, resulting in a total sample size of 111 patients. An Apfel score of 2 was reported in 45.0% of patients, followed by 28.8% of patients scoring 3, with 12.6% scoring one. Only 5.4% of patients scored the highest risk of 4, with 8.2% of patients with no Apfel score documented. Conclusion: Orthopedic patients tend to score 2 or more in their Apfel score placing them at higher risk of postoperative nausea and/or vomiting according to the collectively validated Apfel’s simplified risk score. There was no statistically significant relationship between the Apfel score and the number of antiemetic agents prescribed or administered from both the perioperative and post-operative setting following orthopedic surgery in this cohort of adult patients.
Background: Post-operative nausea and vomiting is a common occurrence amongst surgical patients. Anecdotal reports suggest antiemetic prescribing patterns to be an area for improvement. Aim:To report the most commonly prescribed antiemetic agents in a major tertiary teaching hospital in Australia; and to assess medication dosage and compared to the current national and international guidelines with recommended multimodal therapies.Methods: A retrospective analysis from patients' electronic medical fi les of patients admitted under a surgical unit that underwent operative management during a four week period was conducted.Results: A total of 480 presentations were audited during the 4-week period. Of these, 26 patients had readmissions, resulting in 454 patients screened for inclusion in this audit. A total of 51 patients met the exclusion criteria, leaving 403 patients included in this audit. Ondansetron was the most commonly prescribed antiemetic agent (65.5%), followed by metoclopramide (21.5%) and droperidol (7.4%). A single antiemetic agent was prescribed for 57.3% of patients, compared to 39.2% for multimodal therapies and 3.5% of patients did not have any antiemetic agents charted. Conclusion:The majority of post-operative patients were prescribed ondansetron. The prescription of ondansetron as fi rst line therapy is in line with international guidelines. An area for improvement was highlighted in the prescribing of multimodal therapy for the reduction of post-operative nausea and vomiting. Further studies and providing educational support to address discrepancies in current prescribing practices is recommended to optimise patient health outcomes.
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