Development and assessment of novel machine learning models to predict the probability of postoperative nausea and vomiting for patient-controlled analgesia

Postoperative nausea and vomiting (PONV) can lead to various postoperative complications. The risk assessment model of PONV is helpful in guiding treatment and reducing the incidence of PONV, whereas the published models of PONV do not have a high accuracy rate. This study aimed to collect data from patients in Sichuan Provincial People's Hospital to develop models for predicting PONV based on machine learning algorithms, and to evaluate the predictive performance of the models using the area under the receiver characteristic curve (AUC), accuracy, precision, recall rate, F1 value and area under the precision-recall curve (AUPRC). The AUC (0.947) of our best machine learning model was significantly higher than that of the past models. The best of these models was used for external validation on patients from Chengdu First People's Hospital, and the AUC was 0.821. The contributions of variables were also interpreted using SHapley Additive ExPlanation (SHAP). A history of motion sickness and/or PONV, sex, weight, history of surgery, infusion volume, intraoperative urine volume, age, BMI, height, and PCA_3.0 were the top ten most important variables for the model. The machine learning models of PONV provided a good preoperative prediction of PONV for intravenous patient-controlled analgesia.