Apfel Score

Name: Apfel Score calculator — MedScore
Creator: Nabil Alzein

Simplified risk score for postoperative nausea and vomiting (PONV) in adults

Female sex

Non-smoker

History of PONV or motion sickness

Postoperative opioids expected

About this score

When to use

Estimates the risk of postoperative nausea and vomiting from four predictors: female sex, non-smoking, history of PONV or motion sickness, and postoperative opioids. ⁦[1]⁩

Pearls and pitfalls

Incidence was about 10, 21, 39, 61 and 79% with 0, 1, 2, 3 and 4 factors, in cross-validation between two centres. ⁦[1]⁩

Summarised from the numbered sources under Evidence. Check the source before relying on a statement.

Evidence

[1] Original publication

Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Four predictors — female sex, non-smoking, history of PONV or motion sickness, postoperative opioids — with incidences of about 10, 21, 39, 61 and 79 % for 0–4 factors.

Anesthesiology, 1999

Open source

Last reviewed: 2026-10

Report an error in this calculator

MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.