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Post-Operative Nausea and VomitingMichael Edmonds Post-operative nausea and vomiting (PONV) represents a significant problem in anaesthetic procedures, particularly in the day-surgery patients. It is the most common adverse event in the specialty of anaesthesia and is the most commonly stated fear of patients prior to elective surgery. Despite this, there is no current general consensus regarding the prophylactic management of PONV. This study examined the patient, operation and anaesthetic factors associated with development of PONV, and used the best available evidence to construct an influence diagram and decision model which predicts the risk of PONV, and determines the optimal management in a particular patient. This can be further extended to develop guidelines for future patient management. This study involved extensive literature review, construction of a qualitative and quantitative model (see below) representing the associations of these predictive factors with PONV, and statistical analysis of the predictive accuracy of the model. The final predictive model predicts a general population rate of PONV of 33.4% with no anti-emetics administered, and generated decision thresholds for the most cost-effective choice of anti-emetic. Sensitivity analysis shows that the patient risk factors are the most significant in the development of PONV, and that anaesthetic choice has relatively little effect. Statistical analysis using data from a Royal Adelaide Hospital Day Surgery Unit database indicates that the model produced has a higher error rate than statistical models produced from the data, but has a higher sensitivity to predicting the occurrence of PONV, and will result in less readmissions due to PONV.
Decision Model for PONV
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