Percentage of pediatric patients 3 through 17 years of age, who receive appropriate antiemetic prophylaxis preoperatively and/or intraoperatively.

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 surgery². Effective management of PONV leads to optimal patient outcomes and comfort during the postoperative period.³ Combination therapy that includes two prophylactic pharmacologic anti-emetic agents of different classes is most effective when managing PONV in children.^4,5

A separate PONV risk model should be considered for pediatric patients as many proven risk factors for adults are difficult to assess or do not apply to children.⁶ The independent PONV risk factors identified for pediatrics include post-pubertal females, positive history of PONV (individual and/or immediate family), at risk surgery (strabismus, adenotonsillectomy, otoplasty), administration of long acting opioids and volatile anesthetic duration greater than 30 minutes.¹ 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.^7,8

4 hours before Anesthesia Start to PACU Start

Pediatric patients ≥ 3 and < 18 years old who have one or more risk factors for PONV:

• Age ≥ 3 years
• Females ≥ 12 years of age
• Hx PONV  in patient, parent or sibling 
• Surgery at Risk
  • Procedure Type: Strabismus
  • Procedure Type: Adenotonsillectomy
  • Procedure Type: Tympanoplasty
• Inhaled Anesthetic Duration  ≥ 30 minutes
• Administration of long acting opioids *See Other Measure Build Details

• Age < 3 or  ≥ 18 years
• ASA 5 or 6 including Organ Procurement (CPT: 01990)
• MAC cases (determined by Anesthesia Technique: General value codes: 0,4,5) 
• Patients transferred directly to the ICU
• Procedure Types:
  • Labor Epidurals (determined by Obstetric Anesthesia Type value codes: 3 & 6 including obstetric non-operative procedures - CPT: 01958)
  • Procedures completed in a room with location tag 'Radiation Oncology'
  • MRI without additional procedures
  • ECT

• Patients at low risk for PONV (0 Risk Factors) receive at least one prophylactic pharmacologic antiemetic. 

• Patients at moderate risk for PONV (2 Risk Factors) receive combination therapy consisting of at least two prophylactic pharmacologic antiemetic agents from different classes.

• Patients at high risk for PONV (> 2 Risk Factors) receive three prophylactic pharmacologic antiemetic agents from different classes

All patients are assumed to have 1 risk factor based on age inclusion criteria (3-17yo).

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)

Long Acting Opioids

• Any of the following medications administered after Induction End (if not take the earliest of Anesthesia Ready (50018), Surgery Start Date/Time) and before PACU End
  • 10219    HYDROMORPHONE
  • 10279    MEPERIDINE
  • 10290    METHADONE
  • 10306    MORPHINE
  • 10341    OXYCODONE
  • 10481    OXYCODONE / ACETAMINOPHEN 5 MG / 325 MG
  • 10482    HYDROCODONE / ACETAMINOPHEN 5 MG / 325 MG
  • 10483    HYDROCODONE / ACETAMINOPHEN 7.5 MG / 500 MG

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

Not applicable

Provider(s) signed in at Induction End.

Method for determining Responsible Provider:

1. Provider signed in at Anesthesia Induction End. If not available then,
2. Provider signed in at Anesthesia Induction Start. If not available then,
3. Provider signed in at Surgery Start. If not available then,
4. Provider signed in at Patient in Room. If not available then,
5. Provider signed in Anesthesia Start.

1. Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020;131(2):411-448.
2. Gillmann HJ, Wasilenko S, Zuger J, et al. Standardised electronic algorithms for monitoring prophylaxis of postoperative nausea and vomiting. Archives of medical science : AMS. 2019;15(2):408-415.
3. Collins AS. Postoperative nausea and vomiting in adults: implications for critical care. Critical care nurse. 2011;31(6):36-45.
4. Shen YD, Chen CY, Wu CH, Cherng YG, Tam KW. Dexamethasone, ondansetron, and their combination and postoperative nausea and vomiting in children undergoing strabismus surgery: a meta-analysis of randomized controlled trials. Paediatric anaesthesia. 2014;24(5):490-498.
5. Eberhart LH, Geldner G, Kranke P, et al. The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesthesia and analgesia. 2004;99(6):1630-1637, table of contents.
6. De Oliveira GS, Jr., Castro-Alves LJ, Chang R, Yaghmour E, McCarthy RJ. Systemic metoclopramide to prevent postoperative nausea and vomiting: a meta-analysis without Fujii's studies. British journal of anaesthesia. 2012;109(5):688-697.
7. Schraag S, Pradelli L, Alsaleh AJO, et al. Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis. BMC anesthesiology. 2018;18(1):162.