The Apfel Score is a clinical calculator used to predict the risk of postoperative nausea and vomiting (PONV) in surgical patients. It is named after Dr. Christian C. Apfel, who developed it. The score is based on four risk factors: female gender, history of motion sickness or PONV, non-smoking status, and the use of postoperative opioids. Each risk factor contributes one point to the score, with a maximum score of four. The higher the score, the greater the risk of PONV. 

This calculator is applicable to all adult patients undergoing surgery, particularly those under general anesthesia. It is used to guide prophylactic antiemetic therapy, with the aim of improving patient comfort and satisfaction, and reducing hospital stay and costs. 

The Apfel Score may not be applicable to pediatric patients, or to patients undergoing certain types of surgery (e.g., eye or ear surgery) that have a particularly high risk of PONV. It also does not take into account other potential risk factors for PONV, such as the type and duration of surgery, or the use of volatile anesthetics.

Apfel score for postoperative nausea and vomiting

# Criteria
 ## Gender
A. Male (+0)
B. Female (+1)
## Smoking status
C. Smoker (+0)
D. Non-smoker (+1)
## History of motion sickness or PONV
E. Yes (+1)
F. No (+0)
## Use of postoperative opioids
G. Yes (+1)
H. No (+0)

# Conditions
- score == 0
- score == 1
- score == 2
- score == 3
- score == 4