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4%), and seven (3%) papers, respectively. Postoperative opioid use was defined as "anticipated" in 138 (54%) studies and "actual" in 72 (18%) studies and was unclear in 45 (28%) studies. Significant variation exists in how the Apfel risk factors are defined and applied in PONV research, particularly with respect to postoperative opioid use. More guidance in the application of this tool may optimize risk estimation and PONV prophylaxis, and potentially improve research quality. Significant variation exists in how the Apfel risk factors
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