Dhakal Rajendra, Upadhya Pawan Sapkota, Luitel Prajjwol, Pariyar Suraj, Koirala Bibhav Hari, Kandel Shiva
Department of General Surgery, National Medical College and Teaching Hospital, Birgunj, Nepal.
Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
J Minim Invasive Surg. 2025 Sep 15;28(3):130-136. doi: 10.7602/jmis.2025.28.3.130.
The incidence of postoperative nausea and vomiting (PONV) is variable across different settings. In our setting, no standardized risk assessment strategies exist, leading to sporadic use of antiemetics. This study aims to assess the incidence of PONV in adult patients undergoing laparoscopic cholecystectomy (LC), its predictors, and the effectiveness of the Apfel score and Koivuranta score in predicting PONV after LC in Nepalese patients.
A prospective observational study was conducted among patients undergoing elective LC. Apfel score and Koivuranta score were calculated for each patient. Postoperatively, patients were monitored for nausea and vomiting for 24 hours. Bivariate and multivariate analyses were performed to find the predictors. The receiver operating characteristic (ROC) curve was constructed to compare the scores.
A total of 100 patients were analyzed with mean age of 36 years and female predominance (82%). The mean hospital stay was 2.51 days. Incidence of PONV was 43%. Absence of smoking (odds ratio [OR], 7.66; 95% confidence interval [CI], 1.91-30.78), history of motion sickness (OR, 9.51; 95% CI, 2.63-34.38), and use of postoperative opioids (OR, 7.18; 95% CI, 2.24-23.01) were significantly associated with PONV. The Apfel score (area under the curve [AUC] of 0.809) had slightly superior performance than Koivuranta score (AUC of 0.79).
There is a higher incidence of PONV after LC, with a higher risk in nonsmokers, patients with history of motion sickness, and use of postoperative opioids. Apfel score is an accurate and simpler score than Koivuranta score that can be used for the risk stratification of these patients.
术后恶心呕吐（PONV）的发生率在不同环境中有所不同。在我们的环境中，不存在标准化的风险评估策略，导致止吐药的使用零散。本研究旨在评估接受腹腔镜胆囊切除术（LC）的成年患者中PONV的发生率、其预测因素，以及Apfel评分和Koivuranta评分在预测尼泊尔患者LC术后PONV方面的有效性。
对接受择期LC的患者进行前瞻性观察研究。为每位患者计算Apfel评分和Koivuranta评分。术后，对患者进行24小时的恶心和呕吐监测。进行双变量和多变量分析以找出预测因素。构建受试者工作特征（ROC）曲线以比较评分。
共分析了100例患者，平均年龄36岁，女性占主导（82%）。平均住院时间为2.51天。PONV的发生率为43%。不吸烟（优势比[OR]，7.66；95%置信区间[CI]，1.91 - 30.78）、晕动病史（OR，9.51；95% CI，2.63 - 34.38）和术后使用阿片类药物（OR，7.18；95% CI，2.24 - 23.01）与PONV显著相关。Apfel评分（曲线下面积[AUC]为0.809）的表现略优于Koivuranta评分（AUC为0.79）。
LC术后PONV的发生率较高，在不吸烟者、有晕动病史的患者和术后使用阿片类药物的患者中风险更高。Apfel评分比Koivuranta评分更准确、更简单，可用于这些患者的风险分层。
