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Health·G Space·Evidence-backed gain·Published 2026-08-06

Machine learning-based prediction of postoperative nausea and vomiting after spinal anesthesia: A retrospective observational study

Abstract: Postoperative nausea and vomiting (PONV) is a frequent and serious complication after surgery. PONV also reduces patient satisfaction with surgery under spinal anesthesia and increases medical costs due to prolonged hospitalization. The purpose of this study is to apply artificial intelligence (AI) machine learning analysis to identify risk factors for PONV in patients undergoing surgery with spinal anesthesia. This retrospective study used artificial intelligence to analyze data of adult patients (aged ≥20 year…

TRV-2026-0665Peer-reviewedPermanent record — cite & verify
Machine learning-based prediction of postoperative nausea and vomiting after spinal anesthesia: A retrospective observational study

United States Naval Medical Bulletin Vol. 46 Nos. 1-6, 1946 by U.S. Navy. Bureau of Medicine and Surgery. Public domain

The quick read

A retrospective study at Tohoku University Hospital applied an ensemble of five machine learning algorithms to 4,574 spinal anesthesia cases from 2010 to 2022, using propensity score matching to compare 269 patients with PONV to 269 without, to predict and explain postoperative nausea and vomiting within 24 hours.

The work matters because PONV reduces satisfaction and increases costs after spinal anesthesia, and the model surfaced modifiable contributors like postoperative fentanyl and intrathecal opioids alongside patient factors; uncertainty remains about external validity beyond a single center and whether the identified associations will improve prospective prevention.

Main points
  • Retrospective analysis of 4,574 adult patients at Tohoku University Hospital from 2010 to 2022, with propensity score matching to 538 patients (269 PONV and 269 non-PONV).
  • Ensemble model built from random forest, gradient boosting machine, k-nearest neighbor, multilayer perceptron, and decision tree to predict PONV probability.
  • Anesthesia and surgery-related risk factors included cesarean section, intrathecal fentanyl/morphine, epidural puncture level Th7-12, and shorter surgery and anesthesia durations.
Gain

An ensemble of five machine learning algorithms applied to spinal anesthesia cases identified actionable risk factors for postoperative nausea and vomiting, with postoperative fentanyl as the strongest contributor, and was described as accurate enough to support PONV prediction.

The rundown

Researchers analyzed adult patients aged 20 years or older who had surgery under spinal anesthesia at Tohoku University Hospital between 2010 and 2022, defining PONV as nausea/vomiting or antiemetic use within 24 hours extracted from postoperative records.

After matching, the ensemble model ranked postoperative fentanyl use highest, followed by duration of surgery, BMI, total urine output, and duration of anesthesia, and also flagged female sex, BMI <25, cesarean section, and intrathecal opioid administration as risk factors.

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