Postoperative nausea and vomiting following orthognathic and temporomandibular joint surgery: a prospective two-center cohort study

Abstract This study comprehensively analyzes the incidence and risk factors of postoperative nausea and vomiting(PONV) following orthognathic and temporomandibular joint(TMJ) surgeries. We evaluate the applicability of the Apfel score and personalized risk prediction models in this context to establish an evidence-based foundation for PONV prevention strategies in these surgical patients. This multicenter prospective cohort study enrolled 388 eligible participants who underwent orthognathic or TMJ surgery at West China Hospital of Stomatology (WCCHS) and Peking University Shenzhen Hospital (PUSZH) from April 2025 to June 2025, based on predefined inclusion/exclusion criteria. The WCCHS cohort (April 2025-June 2025; n = 303) served as the training set, while the PUSZH cohort (same period; n = 85) functioned as an external validation set. Independent predictors were identified using Least Absolute Shrinkage and Selection Operator(LASSO)regression, followed by the development of a risk prediction model through logistic regression. The Area Under the Receiver Operating Characteristic Curve༈AUC༉differences between the Apfel risk score and personalized prediction model were then compared across both datasets. The incidence of PONV following orthognathic and TMJ surgery was 58.25%. Significant predictors included female gender, non-smoker, postoperative opioids, and surgical approach (all P < 0.05). The Apfel score achieved an AUC of 0.62 (95% CI: 0.56–0.68) for PONV prediction in this cohort. However, it was significantly outperformed by our novel risk prediction model, which achieved an AUC of 0.73 (P < 0.001) in the training set and an AUC of 0.71 (P = 0.005) in the validation set. Independent predictors for PONV in orthognathic and TMJ surgery patients included: female gender, non-smoker, postoperative opioids, surgical approach, ASA physical status, family history of motion sickness, and a history of PONV. Therefore, incorporating the specific predictors identified in this study into the Apfel score enhances the predictive performance of the new model for PONV risk in this patient population. Patients undergoing orthognathic and TMJ surgery exhibit a high incidence of PONV. Incorporating specific predictors into the Apfel score enhances PONV prediction accuracy in this population, thereby informing evidence-based prophylaxis.