🤢 Apfel Score (Postoperative Nausea & Vomiting)
Predict postoperative nausea and vomiting with the simplified Apfel score.
Clinical takeaway
Each factor adds roughly 18–20% absolute risk.
Loading calculator…
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
When to use
Guide multimodal PONV prophylaxis.
How it works
Female sex, non-smoker, history of PONV/motion sickness, expected postoperative opioids — each 1 point (0–4). Risk ≈ 10/21/39/61/79%.
Key points
- Each factor adds roughly 18–20% absolute risk.
- Scores ≥ 2 warrant multiple antiemetic classes.
- Consider opioid-sparing/TIVA for high risk.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Female sex | No |
|---|---|
| Non-smoker | No |
| History of PONV or motion sickness | No |
| Expected postoperative opioids | No |
→Apfel0/4
- Approx. PONV risk：~10%
- Prophylaxis：Baseline risk; targeted prophylaxis usually sufficient.
| Female sex | Yes (+1) |
|---|---|
| Non-smoker | Yes (+1) |
| History of PONV or motion sickness | Yes (+1) |
| Expected postoperative opioids | Yes (+1) |
→Apfel4/4
- Approx. PONV risk：~79%
- Prophylaxis：Use 1–2 (or more) antiemetics from different classes and consider opioid-sparing/TIVA.
Frequently asked questions
- What is Apfel Score (Postoperative Nausea & Vomiting)?
- Predict postoperative nausea and vomiting with the simplified Apfel score.
- How is Apfel Score (Postoperative Nausea & Vomiting) calculated? What is the core formula?
- Female sex, non-smoker, history of PONV/motion sickness, expected postoperative opioids — each 1 point (0–4). Risk ≈ 10/21/39/61/79%.
- When is Apfel Score (Postoperative Nausea & Vomiting) used?
- Guide multimodal PONV prophylaxis.
- What are the key clinical points for Apfel Score (Postoperative Nausea & Vomiting)?
- Each factor adds roughly 18–20% absolute risk. Scores ≥ 2 warrant multiple antiemetic classes. Consider opioid-sparing/TIVA for high risk.
- What are the limits and cautions when using Apfel Score (Postoperative Nausea & Vomiting)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Apfel Score (Postoperative Nausea & Vomiting) calculated in practice? Can you show a worked example?
- Inputs: Female sex No, Non-smoker No, History of PONV or motion sickness No, Expected postoperative opioids No → Result: Apfel 0 /4（Approx. PONV risk: ~10%, Prophylaxis: Baseline risk; targeted prophylaxis usually sufficient.） Inputs: Female sex Yes (+1), Non-smoker Yes (+1), History of PONV or motion sickness Yes (+1), Expected postoperative opioids Yes (+1) → Result: Apfel 4 /4（Approx. PONV risk: ~79%, Prophylaxis: Use 1–2 (or more) antiemetics from different classes and consider opioid-sparing/TIVA.）