Appropriateness and Associated Factors of Stress Ulcer Prophylaxis for Surgical Inpatients of Orthopedics Department in a Tertiary Hospital: A Cross-Sectional Study

Abstract

Background: Stress ulcer prophylaxis (SUP) prescribed in patients admitted to surgical wards with a low risk of stress-related mucosal disease (SRMD) accounted for a considerable proportion of improper use of proton pump inhibitors (PPIs). This study aimed to analyze the appropriateness of SUP prescribing patterns and identify its associated factors in the orthopedics department of a tertiary hospital in the Northwestern China.Methods: In this cross-sectional study, information regarding the demographic and clinical characteristics of 1,200 fracture inpatients who underwent surgical operations from January 2020 to August 2021 were collected from medical records. Established criteria were used to assess the appropriateness of the prescribing pattern for SUP, and the incidence of inappropriate SUP medication was calculated. Logistic regression analyses were used to identify factors associated with inappropriate SUP medication.Results: Approximately, 42.4% of the study population was interpreted as inappropriate prescription of SUP. A total of 397 (33.1%) patients received SUP without a proper indication (overprescription), and the incidence of inappropriate SUP medication was calculated to be 43.11 per 100 patient-days. In addition, 112 (9.3%) inpatients for whom SUP was indicated did not receive SUP (underprescription). PPIs were prescribed in 96.1% of the inpatients who used acid suppression therapy (AST), and intravenous PPIs accounted for 95.3% thereof. In a multivariate logistic regression analysis, age above 65 years and prolonged hospitalization were associated with overprescription of SUP. Increased number of drugs excluding PPIs, the concurrent use of systemic corticosteroids, comorbidity of hypertension, and unemployed or retired status in inpatients were associated with a reduced likelihood of overprescription for SUP. Conversely, prolonged hospitalization, the concurrent use of systemic corticosteroids or anticoagulants, and unemployed status in inpatients were positively associated with underprescription of SUP.Conclusion: There was a high prevalence of inappropriate SUP prescription among noncritically ill inpatients of fracture who underwent surgical operations. We delineated the associated factors with inappropriate SUP medication, which indicated that more information was required for clinicians about rationality and efficiency of their prescribing practices. Effective intervention strategies should be executed by clinical pharmacists to reduce improper SUP medication.

Analysis of inappropriate prophylactic use of proton pump inhibitors during the perioperative period: an observational study

“…However, another study showed that the concomitant use of aspirin or anticoagulants promoted inappropriate stress ulcer prophylaxis (Issa et al 2012 ). Other studies had found that glucocorticoids were associated with the irrational use of PPIs, but our study did not find a similar conclusion (Li et al 2022 ; Schepisi et al 2016 ). The inappropriate prophylactic use of PPIs was reduced as the length of postoperative hospital stay (longer than 15 days) lengthened.…”

“…Long-term use of PPIs may increase the risk of adverse reactions, especially in the absence of guidance from doctors or pharmacists after discharge. In our study, 78.4% of patients received intravenous PPIs, but only 3.1% of patients had a problem with the inappropriate route of administration, which was significantly lower than in previous studies (Li et al 2022 ). This was attributed to the fact that patients admitted to otorhinolaryngology-head and neck surgery, neurosurgery, thoracic surgery, and other departments could not take medication orally or had gastrointestinal dysfunction after surgery.…”

“…Owing to concern about the risk of perioperative gastrointestinal bleeding, clinicians often prescribe PPIs to patients. In fact, the risk of perioperative gastrointestinal bleeding is only 4%, so there is no need to prescribe PPIs to prevent SRMD in low-risk perioperative patients (Li et al 2022 ). Superior efficacy for acid suppression and the availability of generic formulations have led prescribers to favor the use of PPIs.…”

“…In recent years, PPIs have been widely used in the prevention of SRMD, especially in the perioperative period, and the problem of irrational drug use has become increasingly prominent (Chen et al 2022 ; Savarino et al 2018 ). The inappropriate prophylactic use of PPIs has not only increased the economic burden on patients, and caused the waste of medical resources, but has also raised the potential medical risks (Li et al 2022 ). Therefore, the Chinese authorities have taken various measures to manage the inappropriate prophylactic use of PPIs and decrease medical costs.…”

The prevalence of chronic medication therapy problems and pharmacists’ interventions among hospitalized perioperative patients: a retrospective observational study

“…Many studies have documented the positive effect of pharmacy services on patients with chronic diseases in different settings, and some of these findings have supported the active involvement of pharmacists to optimize the medication management of perioperative patients [6][7][8][9]. Previous studies have focused on medication reconciliation and the DRPs of the medication orders in surgical wards [6,7,10,11]. Very few studies have been conducted on the characteristics of CMTPs in surgical wards and the outcomes of the pharmacists' interventions.…”