PONV 03: Percentage of patients, regardless of age, who undergo a procedure and have a documented nausea/emesis occurrence OR receive a rescue antiemetic in the immediate postoperative period.

PONV 03b: Percentage of patients, regardless of age who undergo a procedure and have a documented nausea/emesis occurrence with or without receiving an antiemetic in the immediate postoperative period.

Postoperative nausea and vomiting (PONV) is a common and unpleasant outcome of anesthesia care that can lead to other complications, lengthening the patient’s recovery period after surgery. Effective management of PONV leads to optimal patient outcomes and comfort during the postoperative period. The Apfel score is one of the most common risk predictors for PONV and is based on 4 variables: female gender, non-smoking status, history of PONV or motion sickness and postoperative opioid administration. The presence of each additional risk factor increases a patient’s risk of PONV by twenty percent. Although including a prophylactic anti-emetic administration protocol that considers such risk factors has shown to reduce the incidence of PONV, there is high variability in this outcome. For the purpose of this measure, PONV is defined as administering any rescue medication (antiemetic MPOG Concepts in table below) or documentation of nausea or vomiting in the immediate postoperative period.

PACU Start to 6 hours after Anesthesia End

All patients requiring anesthesia.

• ASA 6 including Organ Procurement
• Patients transferred directly to the ICU
• Procedures:
  • Labor Epidurals (determined by Obstetric Anesthesia Type value codes: 3 & 6 including obstetric non-operative procedures - CPT: 01958)
  • Liver Transplants 
  • Lung Transplants 
• Procedures completed in a room with location tag 'Radiation Oncology'

Patient does not report nausea, have an emesis event or receive an antiemetic during the immediate postoperative period.

• Only antiemetics given via the following routes will be considered:
  • 2001 IV
  • 2003 Intramuscular
  • 2008 Oral
  • 2011 Sublingual
  • 2012 Rectal
  • 2022 Intraosseous
  • 2023 Enteric Tube
  • 2997 Other - Not Listed
  • 2998 Other - Not Specified
  • 2999 Other
  • For scopolamine only: Topical (2013) or Transdermal (2027)
• Antiemetics documented in mL (ID: 1025) will be excluded.
• Antiemetic infusions (ml/hr) initiated intraop and continuing postoperatively will be excluded. However, antiemetic infusions initiated after anesthesia end will be considered. (Route Concept ID: 1100)

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Pending

For cases > 60 minutes: Provider(s) for a given case who are signed in ≥ 40 minutes OR  All provider(s) signed into the case if no provider is signed in for ≥ 40 minutes.

For cases ≤ 60 minutes: All provider(s) are attributed.

Algorithm for determining Case Duration:

• Start
  • Patient In Room. If not available, then
  • Induction End. If not available, then
  • Anesthesia Start
• End
  • Patient out of room. If not available, then
  • Anesthesia End

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3. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia and analgesia. 2014;118(1):85-113.
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