Prevention of Post-Operative Vomiting (POV) – Combination Therapy (Pediatrics)
Percentage of patients aged 3 through 17 years, who undergo a procedure under general anesthesia in which an inhalational anesthetic is used for maintenance AND who have two or more risk factors for post-operative vomiting (POV), who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively.
Last updated: January 15, 2026
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Estimate only — actual CMS scoring may vary based on reporting method, data completeness, and annual rule updates.
📖Clinical Rationale
Postoperative nausea and vomiting (PONV) is an important patient-centered outcome of anesthesia care. PONV is highly dis-satisfying to patients, although rarely life-threatening. A large body of scientific literature has defined risk factors for PONV and has demonstrated effective prophylactic regimes based on these risk factors and demonstrated high variability in this outcome across individual centers and providers.
Between 62-73% of children experience POV when prophylactic anti-emetics are not administered. Beyond the discomfort associated with the condition, POV is a comorbidity which can cause significant postoperative complications, including dehydration and postoperative bleeding. In several studies, incidence of POV decreased significantly in children receiving combination therapy compared to control groups not receiving combination therapy for POV.
Further, a number of papers have shown that performance can be assessed at the level of individual providers -- the outcome is common enough that sufficient power exists to assess variability and improvement at this level. A separate measure is needed for pediatric patients because the risk factors and recommended prophylaxis are different from adults.
📝Clinical Recommendations
Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting; Society for Ambulatory Anesthesia (SAMBA), 2020 Administer prophylactic antiemetic therapy to children at increased risk for POV; as in adults, use of combination therapy is most effective. All prophylaxis in children at moderate or high risk for POV should include combination therapy using a 5-HT3 antagonist and a second drug.
Because the effects of interventions from different drug classes are additive, combining interventions has an additive effect in risk reduction.
📋Implementation Notes
This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period.
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