New Dawn for PONV Management: Study Validates Simplified Severity Score
Recent observational study aimed to validate the Rhodes Index of Nausea, Vomiting, and Retching (RINVR) scale for assessing postoperative nausea and vomiting (PONV) intensity and to develop a simplified scoring system—Simplified PONV Severity Score (SPONVSS)—to evaluate its effects on sleep quality and vitality in patients undergoing surgery.
Significance of PONV
PONV is a prevalent complication affecting approximately one-third of surgical patients, significantly impacting their recovery. While existing guidelines primarily focus on PONV incidence, this study sought to address severity, recognizing that patients' experiences of nausea and vomiting can vary widely. The complexity of the RINVR scale, however, prompted the researchers to create a more accessible metric. SPONVSS comprises three elements: vomiting times, retching times, and nausea frequency, scored on a scale from 0 to 4. The validation process involved a cohort of 967 patients, assessing the correlation between SPONVSS scores and prescribed antiemetics, as well as postoperative outcomes related to sleep and vitality.
Statistical Findings
Statistical analysis revealed strong associations between higher SPONVSS scores (≥ 3) and the need for rescue antiemetics, as well as poor sleep quality and vitality. Specifically, patients classified with severe PONV—indicated by SPONVSS ≥ 3—demonstrated significant increases in antiemetic administration (38.2%) compared to those with lower scores (1.2%). The study also found that only 8% of patients with severe PONV reported good sleep.
Predictive Validity of the RINVR
The RINVR's predictive validity was established through area under the curve (AUC) analysis, indicating strong performance in forecasting both antiemetic usage and associated quality of life outcomes. The decision to finalize SPONVSS elements was based on the combined metrics' superior predictive power exhibited in ROC analyses.
Implications of Findings
Importantly, the findings suggest that PONV intensity independently influences sleep and vitality postoperatively, reinforcing the necessity for enhanced PONV management strategies. Additionally, demographic factors such as age, sex, and surgical type were analyzed concerning their roles in PONV severity, with variations in outcomes identified.
Conclusion and Future Research
Overall, by establishing a simplified tool for assessing PONV severity, the study aims to improve postoperative care and patient recovery through more precise management of antiemetic prescriptions, ultimately facilitating better sleep and vitality outcomes for surgical patients. Future research is encouraged to integrate objective measures of sleep quality to strengthen the findings.
Key Points
- -Validation of RINVR and Development of SPONVSS-: The study validates the Rhodes Index of Nausea, Vomiting, and Retching (RINVR) for assessing postoperative nausea and vomiting (PONV) intensity and introduces the Simplified PONV Severity Score (SPONVSS) as a more accessible tool for evaluating PONV effects on sleep quality and vitality. SPONVSS includes three parameters: vomiting frequency, retching frequency, and nausea frequency.
- -Prevalence and Impact of PONV-: Approximately one-third of surgical patients experience PONV, significantly hindering recovery. While guideline emphasis has traditionally been on incidence, this research highlights the importance of severity in shaping patient experiences and outcomes related to nausea and vomiting.
- -Correlation with Postoperative Outcomes-: Statistical analysis demonstrated a strong correlation between SPONVSS scores (≥ 3) and increased rescue antiemetic utilization, alongside diminished sleep quality and vitality. Specifically, 38.2% of patients with severe PONV required additional antiemetics, contrasting sharply with just 1.2% in lower score groups, and only 8% of these patients reported good sleep quality.
- -Predictive Validity Assessment-: Through area under the curve (AUC) analyses, the RINVR exhibited strong predictive validity for anticipating antiemetic requirements and related quality of life outcomes, leading to the selection of SPONVSS components based on superior predictive accuracy demonstrated in ROC analyses.
- -Influence of Demographic Factors-: The study assessed the impacts of demographic variables such as age, sex, and type of surgery on PONV severity, revealing noted variability in outcomes associated with these factors, which could influence clinical PONV management strategies.
- -Implications for Management and Future Research-: Findings signal a clear link between PONV intensity and postoperative sleep and vitality, underscoring the need for improved management protocols. Future investigations are recommended to incorporate objective metrics for sleep quality to enhance and validate these findings.
Reference –
Shih-Feng Weng et al. (2025). A Prospective Cohort Observational Study To Validate A Simplified Postoperative Nausea And Vomiting Severity Scale And Its Effects On Sleep And Vitality. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03074-2.
