Dose-response relationship of dexamethasone for postoperative nausea and vomiting: A retrospective stratified analysis based on Apfel score

Objective To determine the dose-response relationship of dexamethasone for PONV prophylaxis, considering the patient's Apfel risk score. Methods A retrospective study analyzed a sample of 99 adult surgical patients receiving dexamethasone for PONV prophylaxis, stratified by Apfel score. Data were extracted from electronic medical records, including demographics, anesthetic and surgical variables, and PONV outcomes. A logistic regression model was used to evaluate the interaction between dexamethasone dose and Apfel score on PONV incidence. Results The PONV incidence was 34% overall. A significant interaction was found between dexamethasone and Apfel score (p = 0.0325), with 10 mg demonstrating superior efficacy in high-risk patients (Apfel scores 3–4). No ceiling effect was observed t this dose. Low-risk patients (Apfel scores 0–2) showed minimal benefit from dexamethasone. Conclusion Dexamethasone’s antiemetic efficacy follows a dose-dependent relationship, with maximal benefit observed at 10 mg in high-risk patients (Apfel scores 3–4), while offering minimal advantage in low-risk populations (Apfel scores 0–2).