Validation of APFEL score postoperative nausea and vomiting (PONV) risk-based prevention in adult patients undergoing elective abdominal surgery at Kigali University Teaching Hospital, Rwanda

Abstract

Background: The efficacy of postoperative nausea and vomiting (PONV) prevention protocols in low and middle-income settings is not well known, and differences in surgical procedures, available medications, and co-existing diseases imply that existing protocols may need to be validated in those settings. The purpose of this study was to determine the impact of a risk-directed PONV prevention protocol on the incidence of PONV and short-term surgical outcomes in various resource settings. Methods: We compared the incidence of PONV during the first 48 hours postoperatively in the period with routine practice versus after implementation of an Apfel score-based PONV prevention strategy among 116 adult patients undergoing elective open abdominal surgery at Kigali University Teaching Hospital (58 patients for each period) between April 2019 and September 2019. Time to first oral intake, hospital length of stay, and rates of wound dehiscence were compared between the two periods by using the chi-square and Mann-Whitney U tests accordingly. Results: The overall pre-intervention incidence of PONV during the first 48 hours postoperatively was 84.5% for nausea and 74.1% for vomiting. This incidence was reduced in the post-intervention period to 31.0% for nausea (p< 0.001) and 13.8% for vomiting (p< 0.001). The intervention was also associated with a significant reduction in the time to first oral intake, from 24[24-36] to 17.5[12-24] hours (p< 0.001). The hospital length of stay was also significantly lower in the post-intervention period compared with the pre-intervention one (5[3-7] days versus 4[2-6] days; p<0.020). Signs of wound dehiscence tended to be more observed in the pre than in the post intervention period (10.3% versus 3.5%; p<0.271) without a significant difference Conclusion: This study has demonstrated the potential value to implement PONV prevention protocol in resource-limited settings. Risk-directed PONV prophylaxis is possible and effective in a low-income country and improves postoperative outcomes.