{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:41:50Z","timestamp":1788259310663,"version":"build-2803163510"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T00:00:00Z","timestamp":1723680000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["22K10211"],"award-info":[{"award-number":["22K10211"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["21K19588"],"award-info":[{"award-number":["21K19588"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Postoperative nausea and vomiting (PONV) is a common adverse effect of anesthesia. Identifying risk factors for PONV is crucial because it is associated with a longer stay in the post-anesthesia care unit, readmissions, and perioperative costs. This retrospective study used artificial intelligence to analyze data of 37,548 adult patients (aged \u226520 years) who underwent surgery under general anesthesia at Tohoku University Hospital from January 1, 2010 to December 31, 2019. To evaluate PONV, patients who experienced nausea and\/or vomiting or used antiemetics within 24 hours after surgery were extracted from postoperative medical and nursing records. We create a model that predicts probability of PONV using the gradient tree boosting model, which is a widely used machine learning algorithm in many applications due to its efficiency and accuracy. The model implementation used the LightGBM framework. Data were available for 33,676 patients. Total blood loss was identified as the strongest contributor to PONV, followed by sex, total infusion volume, and patient\u2019s age. Other identified risk factors were duration of surgery (60\u2013400 min), no blood transfusion, use of desflurane for maintenance of anesthesia, laparoscopic surgery, lateral positioning during surgery, propofol not used for maintenance of anesthesia, and epidural anesthesia at the lumbar level. The duration of anesthesia and the use of either sevoflurane or fentanyl were not identified as risk factors for PONV. We used artificial intelligence to evaluate the extent to which risk factors for PONV contribute to the development of PONV. Intraoperative total blood loss was identified as the potential risk factor most strongly associated with PONV, although it may correlate with duration of surgery, and insufficient circulating blood volume. The use of sevoflurane and fentanyl and the anesthesia time were not identified as risk factors for PONV in this study.<\/jats:p>","DOI":"10.1371\/journal.pone.0308755","type":"journal-article","created":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T17:43:47Z","timestamp":1723743827000},"page":"e0308755","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Machine learning-based identification of the risk factors for postoperative nausea and vomiting in adults"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1466-6228","authenticated-orcid":true,"given":"Hiroshi","family":"Hoshijima","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5205-0542","authenticated-orcid":true,"given":"Tomo","family":"Miyazaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2525-4837","authenticated-orcid":true,"given":"Yuto","family":"Mitsui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichiro","family":"Omachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Yamauchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Mizuta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,15]]},"reference":[{"issue":"1","key":"pone.0308755.ref001","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/MJT.0b013e3181e7a512","article-title":"Postoperative nausea and vomiting prophylaxis from an economic point of view.","volume":"19","author":"R Dzwonczyk","year":"2012","journal-title":"Am J Ther"},{"key":"pone.0308755.ref002","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.jclinane.2017.06.007","article-title":"Another quest for the holy grail of abolishing post operative nausea and vomiting","volume":"41","author":"V Tateosian","year":"2017","journal-title":"J Clin Anesth"},{"issue":"1","key":"pone.0308755.ref003","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/oxfordjournals.bja.a013383","article-title":"Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients","volume":"84","author":"PS Myles","year":"2000","journal-title":"Br J Anaesth"},{"issue":"4","key":"pone.0308755.ref004","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.bpa.2020.07.003","article-title":"Clinical and economic burden of postoperative nausea and vomiting: Analysis of existing cost data.","volume":"34","author":"K Gress","year":"2020","journal-title":"Best Pract Res Clin Anaesthesiol"},{"issue":"3","key":"pone.0308755.ref005","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1213\/00000539-199909000-00022","article-title":"Which clinical anesthesia outcomes are important to avoid? The perspective of patients.","volume":"89","author":"A Macario","year":"1999","journal-title":"Anesth Analg"},{"issue":"1","key":"pone.0308755.ref006","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1213\/ANE.0000000000000002","article-title":"Consensus guidelines for the management of postoperative nausea and vomiting.","volume":"118","author":"TJ Gan","year":"2014","journal-title":"Anesth Analg"},{"issue":"2","key":"pone.0308755.ref007","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.bpa.2018.06.005","article-title":"What is new in the battle against postoperative nausea and vomiting?","volume":"32","author":"VS Tateosian","year":"2018","journal-title":"Best Pract Res Clin Anaesthesiol."},{"issue":"3","key":"pone.0308755.ref008","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/ALN.0b013e318267ef31","article-title":"Who is at risk for postdischarge nausea and vomiting after ambulatory surgery?","volume":"117","author":"CC Apfel","year":"2012","journal-title":"Anesthesiology"},{"issue":"5","key":"pone.0308755.ref009","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1097\/ALN.0000000000001057","article-title":"Severe Nausea and Vomiting in the Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia II Trial","volume":"124","author":"PS Myles","year":"2016","journal-title":"Anesthesiology"},{"issue":"1","key":"pone.0308755.ref010","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/00000542-199207000-00023","article-title":"Postoperative nausea and vomiting. Its etiology, treatment, and prevention","volume":"77","author":"MF Watcha","year":"1992","journal-title":"Anesthesiology"},{"issue":"2","key":"pone.0308755.ref011","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1093\/bja\/76.2.186","article-title":"Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials","volume":"76","author":"M Tramer","year":"1996","journal-title":"Br J Anaesth"},{"issue":"7","key":"pone.0308755.ref012","first-page":"327","article-title":"Physiology of postoperative nausea and vomiting.","volume":"53","author":"CJ Broomhead","year":"1995","journal-title":"Br J Hosp Med"},{"issue":"5","key":"pone.0308755.ref013","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1093\/bja\/88.5.659","article-title":"Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design","volume":"88","author":"CC Apfel","year":"2002","journal-title":"Br J Anaesth"},{"key":"pone.0308755.ref014","article-title":"Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: an abridged Cochrane network meta-analysis(&ddagger; section sign).","author":"S Weibel","year":"2020","journal-title":"Anaesthesia."},{"issue":"10","key":"pone.0308755.ref015","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1109\/TPAMI.2015.2505293","article-title":"Hybrid Deep Learning for Face Verification","volume":"38","author":"Y Sun","year":"2016","journal-title":"IEEE Trans Pattern Anal Mach Intell"},{"issue":"2","key":"pone.0308755.ref016","doi-asserted-by":"crossref","DOI":"10.3390\/s18020456","article-title":"Deep Learning-Based Gaze Detection System for Automobile Drivers Using a NIR Camera Sensor.","volume":"18","author":"RA Naqvi","year":"2018","journal-title":"Sensors (Basel)."},{"issue":"10201","key":"pone.0308755.ref017","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/S0140-6736(19)31721-0","article-title":"An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction","volume":"394","author":"ZI Attia","year":"2019","journal-title":"Lancet"},{"issue":"1","key":"pone.0308755.ref018","doi-asserted-by":"crossref","first-page":"5642","DOI":"10.1038\/s41467-019-13647-8","article-title":"Automated acquisition of explainable knowledge from unannotated histopathology images.","volume":"10","author":"Y Yamamoto","year":"2019","journal-title":"Nat Commun."},{"issue":"5","key":"pone.0308755.ref019","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1214\/aos\/1013203451","article-title":"Greedy function approximation: A gradient boosting machine.","volume":"29","author":"JH Friedman","year":"2001","journal-title":"Ann Stat"},{"key":"pone.0308755.ref020","article-title":"LightGBM: A Highly Efficient Gradient Boosting Decision Tree.","volume":"30","author":"GL Ke","year":"2017","journal-title":"Adv Neur In."},{"issue":"10","key":"pone.0308755.ref021","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1073\/pnas.39.10.1095","article-title":"Stochastic Games.","volume":"39","author":"LS Shapley","year":"1953","journal-title":"P Natl Acad Sci USA"},{"issue":"1","key":"pone.0308755.ref022","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1038\/s42256-019-0138-9","article-title":"From Local Explanations to Global Understanding with Explainable AI for Trees.","volume":"2","author":"SM Lundberg","year":"2020","journal-title":"Nat Mach Intell"},{"key":"pone.0308755.ref023","first-page":"4768","article-title":"A Unified Approach to Interpreting Model Predictions","author":"SM Lundberg","year":"2017","journal-title":"Proceedings of the 31st International Conference on Neural Information Processing Systems (NIPS\u201917)."},{"issue":"1","key":"pone.0308755.ref024","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1148\/radiology.143.1.7063747","article-title":"The meaning and use of the area under a receiver operating characteristic (ROC) curve.","volume":"143","author":"JA Hanley","year":"1982","journal-title":"Radiology"},{"issue":"1","key":"pone.0308755.ref025","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1177\/1756283X15618131","article-title":"Nausea: a review of pathophysiology and therapeutics.","volume":"9","author":"P Singh","year":"2016","journal-title":"Therap Adv Gastroenterol"},{"key":"pone.0308755.ref026","article-title":"Association between intraoperative hypotension and postoperative nausea and vomiting: a retrospective analysis of 247 thyroidectomy cases.","author":"H Nakatani","year":"2021","journal-title":"Braz J Anesthesiol."},{"issue":"2","key":"pone.0308755.ref027","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1213\/00000539-200302000-00056","article-title":"Intraoperative colloid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration.","volume":"96","author":"EW Moretti","year":"2003","journal-title":"Anesth Analg"},{"issue":"2","key":"pone.0308755.ref028","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1097\/00000542-200302000-00036","article-title":"Postoperative nausea and vomiting in regional anesthesia: a review","volume":"98","author":"A Borgeat","year":"2003","journal-title":"Anesthesiology"},{"issue":"9","key":"pone.0308755.ref029","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1016\/j.soard.2021.06.004","article-title":"Perioperative hemodynamic optimization in laparoscopic sleeve gastrectomy using stroke volume variation to reduce postoperative nausea and vomiting","volume":"17","author":"HJ Cho","year":"2021","journal-title":"Surg Obes Relat Dis"},{"issue":"5","key":"pone.0308755.ref030","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1111\/j.1365-2044.1997.117-az0113.x","article-title":"A survey of postoperative nausea and vomiting.","volume":"52","author":"M Koivuranta","year":"1997","journal-title":"Anaesthesia"},{"key":"pone.0308755.ref031","article-title":"Enhancing estimation methods for integrating probability and nonprobability survey samples with machine-learning techniques. An application to a Survey on the impact of the COVID-19 pandemic in Spain","author":"MDM Rueda","year":"2022","journal-title":"Biom J."},{"issue":"1","key":"pone.0308755.ref032","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1093\/bjaceaccp\/mks046","article-title":"Nausea and vomiting after surgery.","volume":"13","author":"S\u00e9bastien Pierre","year":"2013","journal-title":"Continuing Education in Anaesthesia Critical Care & Pain."},{"issue":"5","key":"pone.0308755.ref033","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.3349\/ymj.2014.55.5.1430","article-title":"Incidence and risk factors of postoperative nausea and vomiting in patients with fentanyl-based intravenous patient-controlled analgesia and single antiemetic prophylaxis.","volume":"55","author":"JB Choi","year":"2014","journal-title":"Yonsei Med J."},{"issue":"9","key":"pone.0308755.ref034","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1046\/j.1365-2044.1998.00516.x","article-title":"Postoperative nausea and vomiting in arthroscopic day-case surgery: a comparison between desflurane and isoflurane","volume":"53","author":"MB Hough","year":"1998","journal-title":"Anaesthesia"},{"issue":"12","key":"pone.0308755.ref035","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1111\/pan.13268","article-title":"Total intravenous anesthesia vs single pharmacological prophylaxis to prevent postoperative vomiting in children: A systematic review and meta-analysis.","volume":"27","author":"MS Schaefer","year":"2017","journal-title":"Paediatr Anaesth"},{"issue":"1","key":"pone.0308755.ref036","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1093\/ajhp\/62.1.63","article-title":"Meta-analysis of trials comparing postoperative recovery after anesthesia with sevoflurane or desflurane.","volume":"62","author":"A Macario","year":"2005","journal-title":"Am J Health Syst Pharm"},{"issue":"2","key":"pone.0308755.ref037","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1213\/ANE.0000000000004833","article-title":"Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting.","volume":"131","author":"TJ Gan","year":"2020","journal-title":"Anesth Analg."},{"issue":"1","key":"pone.0308755.ref038","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/00000542-199907000-00018","article-title":"Can postoperative nausea and vomiting be predicted?","volume":"91","author":"DR Sinclair","year":"1999","journal-title":"Anesthesiology"},{"issue":"2","key":"pone.0308755.ref039","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.ijgo.2010.11.022","article-title":"Comparative study of dexamethasone and ondansetron for prophylaxis of postoperative nausea and vomiting in laparoscopic gynecologic surgery","volume":"113","author":"N D\u2019Souza","year":"2011","journal-title":"Int J Gynaecol Obstet"},{"issue":"6","key":"pone.0308755.ref040","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1097\/00000542-199912000-00045","article-title":"Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials","volume":"91","author":"JB Dahl","year":"1999","journal-title":"Anesthesiology"},{"issue":"7","key":"pone.0308755.ref041","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1017\/S026502150600038X","article-title":"Opioid-related side-effects after intrathecal morphine: a prospective, randomized, double-blind dose-response study.","volume":"23","author":"W Raffaeli","year":"2006","journal-title":"Eur J Anaesthesiol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308755","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T17:44:54Z","timestamp":1723743894000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308755"}},"subtitle":[],"editor":[{"given":"Kuo-Cherh","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,15]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0308755","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,15]]}}}