🤢 Postoperative Nausea & Vomiting Risk (Apfel simplified score)
The Apfel simplified score predicts postoperative nausea and vomiting (PONV) after general anesthesia from four risk factors, guiding the intensity of antiemetic prophylaxis.
Postoperative Nausea & Vomiting Risk (Apfel simplified score)
Female
Non-smoker
History of PONV or motion sickness
Postoperative opioid use
When to use
Use preoperatively to estimate PONV risk and decide on single-agent versus multimodal prophylaxis and anesthetic technique (e.g. TIVA, opioid reduction).
How it works
One point each for female sex, non-smoker, history of PONV/motion sickness, and postoperative opioid use. 0/1/2/3/4 factors ≈ 10/20/40/60/80% PONV risk.
Key points
- Each additional risk factor raises PONV risk by roughly 20%, and prophylaxis is generally recommended once two or more factors are present. (original synthesis · not guideline verbatim)
- High-risk patients (≥ 3 factors) benefit from multimodal prophylaxis combining 2–3 antiemetics plus total intravenous anesthesia and opioid sparing.
- The score can be combined with the Koivuranta score, which adds age and surgery duration.
References
- Apfel CC, et al. A simplified risk score for predicting postoperative nausea and vomiting. Anesthesiology 1999.
- Gan TJ, et al. Fourth Consensus Guidelines for the Management of PONV. Anesth Analg 2020.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.