Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2019.03.006
Brazilian Journal of Anesthesiology
Scientific Article

Development of a multivariable predictive model for postoperative nausea and vomiting after cancer surgery in adults

Desenvolvimento de um modelo preditivo multivariado para náusea e vômito no pós-operatório de cirurgia oncológica em adultos

Léia Alessandra Pinto Yamada, Gabriel Magalhães Nunes Guimarães, Magda Aparecida Santos Silva, Angela Maria Sousa, Hazem Adel Ashmawi

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Abstract

Background and objectives: Predicting postoperative nausea and vomiting risk is the cornerstone for deciding prophylaxis. Apfel’s score does not define how long a person must be abstinent from smoking to be considered a non-smoker, and the use of intraoperative spinal opioids as a risk factor for predicting postoperative nausea and vomiting is also not addressed. The aim of this study was to quantify predicting postoperative nausea and vomiting risk by an ordinal smoking status and the use of intraoperative opioids (systemic or neuraxial), and to develop a new predictive model. Methods: Patients scheduled for cancer surgery were prospectively evaluated for predicting postoperative nausea and vomiting in the first 24 h after surgery. Results: Of 2014 initially included patients, 185 participants were excluded. Smoking status classification was associated with predicting postoperative nausea and vomiting incidence rates of 14.1%, 18.1%, 24.7%, 29.4% and 33.9% for smokers, patients who stopped smoking up to 1 month prior to surgery, one to 6 months prior, more than 6 months prior or patients who never smoked, respectively, which was significant in the multiple comparisons analysis (adjusted p = 0.015). The multiple comparisons-adjusted hypothesis tests for association with predicting postoperative nausea and vomiting for sex, age, previous predicting postoperative nausea and vomiting, chemotherapy-induced nausea, and ordinal smoking status had p-values of <0.001. The type of surgery (p = 0.04), total fentanyl consumption (p = 0.04), both intraoperative and postoperative, were significant predictors. A new model was developed and showed higher discriminative power than Apfel’s score (AUC 67.9% vs. 63.7%, p < 0.001). Conclusion: Smoking status showed a significant and linear impact on predicting postoperative nausea and vomiting incidence, and we developed a new model that uses unambiguous smoking and opioid predictors.

Keywords

Postoperative nausea and vomiting; Multivariable model; Cancer; Smoking; Prognostic

Resumo

Justificativa e objetivos: A previsão do risco de náusea e vômito no pós-operatório é a base para a decisão da profilaxia. O escore de Apfel não define por quanto tempo uma pessoa deve se abster de fumar para ser considerada não fumante, e o uso de opioide espinhal intraoperatório como fator de risco para náusea e vômito também não é abordado. Nosso objetivo foi quantificar o risco de náusea e vômito no pós-operatório por um estado tabagístico ordinal e o uso de opioides intraoperatórios (sistêmicos ou neuraxiais) e desenvolver um novo modelo preditivo. Métodos: Pacientes agendados para cirurgia oncológica foram prospectivamente avaliados para náusea e vômito nas primeiras 24 horas após a cirurgia. Resultados: De 2.014 pacientes inicialmente incluídos, 185 participantes foram excluídos. A classificação de tabagismo foi associada a taxas de incidência de náusea e vômito no pós-operatório de 14,1%, 18,1%, 24,7%, 29,4% e 33,9% para fumantes, pacientes que pararam de fumar até um mês antes da cirurgia, de um a seis meses antes da cirurgia, mais de seis meses antes da cirurgia ou pacientes que nunca fumaram, respectivamente, o que foi significativo na análise de comparações múltiplas (p = 0,015 ajustado). Os testes de hipóteses foram ajustadas para múltiplas comparações para associação com náusea e vômito no pós-operatório para sexo, idade, náusea e vômito no pós-operatório anterior, náusea induzida por quimioterapia e estado tabagístico ordinal apresentaram valores de p < 0,001. Tipo de cirurgia (p = 0,04), consumo total de fentanil (p = 0,04) e períodos intraoperatório e pós-operatório foram preditivos significativos. Um novo modelo foi desenvolvido e apresentou um poder discriminativo maior que o escore de Apfel (AUC 67,9% vs. 63,7%, p < 0,001). Conclusão: O estado tabagístico mostrou um impacto significativo e linear sobre a incidência de náusea e vômito no pós-operatório e desenvolveu-se um novo modelo que usa preditores não ambíguos de tabagismo e opioides.

Palavras-chave

Náusea e vômito no pós-operatório; Modelo multivariado; Câncer; Tabagismo; Prognóstico

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