Current practice of stress ulcer prophylaxis in a surgical patient cohort in a German university hospital

Abstract

Introduction Stress ulcer prophylaxis (SUP) has been a widespread practice both in intensive care units (ICU) and internal wards at the beginning of the twenty-first century. Clinical data suggests an important overuse of acid suppressive therapy (AST) for this indication. Data on current clinical practice of SUP in surgical patients in a non-ICU setting are spares. In the light of a growing number of reports on serious side effects of AST, this study evaluates the use of AST for SUP in a normal surgical ward in a German university hospital. Methods Between January 2016 and June 2016, SUP was analysed retrospectively in 1132 consecutive patients of the Department of Surgery of the Universitätsmedizin Greifswald. Results The patients managed with and without SUP were similar with respect to demographic data and treatment with anticoagulants, SSRI and glucocorticoids. Patients with SUP were treated more frequently by cyclooxygenase inhibiting drugs (NSAID, COX2-inhibitors), were more frequently treated in the intermediated care unit and had a longer hospital stay. Risk factors for the development of stress ulcers were similarly present in patient groups managed with and without SUP. About 85.7–99.6% of patients were given SUP without an adequate risk for stress ulcer development, depending on the method used for risk assessment. Discussion Still today, SUP is widely overused in non-ICU surgical patients. Information campaigns on risk factors for stress ulcer development and standard operating procedures for SUP are required to limit potential side effects and increased treatment costs.

Current Practice of Stress Ulcer Prophylaxis in Surgical Departments in Mecklenburg Western Pomerania, Germany

“…This finding indicates the presence of significant uncertainty surrounding the correct indication for SUP. Moreover, in our survey, the risk for stress ulcer-related bleeding was massively overestimated, confirming previous findings indicating that although the relative risk of developing stress ulcer-related bleeding can be correctly assessed by the treating physician, the absolute risk is generally overestimated [25]. Compared with previous surveys, which showed a critical overestimation of the incidence of stress ulcer-induced bleeding in less than 50% of participants, the current investigation revealed a far more pronounced overestimation rate of 64.9%.…”

“…In a mixed medical-surgical patient population, Parente et al reported the start of ASM in 37% of patients upon admission to the hospital [11]. Our research group recently assessed the ASM prescription routine for SUP on non-ICU surgical wards in a German university hospital: SUP was initiated in 40.3% of patients admitted to the normal surgical ward, and for 85.7-99.6% of those patients, no adequate indication for SUP could be identified retrospectively [25]. Thus, although the first report on the non-indicated over-prescription of ASM for SUP was published more than 20 years ago [1], and although a plethora of literature documents this phenomenon in medical and intensive care patients, current surgical perioperative practice seems as yet unaffected by this scientific evidence.…”

“…Other authors found that up to 86.7% patients discharged from ICUs were unnecessarily exposed to ASM [28]. A lack of regular reassessment of SUP indication may be one critical point responsible for SUP overuse since patients sojourning on the IMC during hospital stays are more likely to be started on non-indicated SUP than patients on GHWs [25].…”

“…Both the lack of guidelines recommending routine SUP in non-critically ill patients and the growing list of known side effects of ASM put pressure on hospital practitioners to strictly limit SUP to patients with proven risk factors. However, in a recent study with 1132 surgical patients in a university hospital in the north of Germany, the authors found inappropriate ASM administration in 85.7-99.6% of patients put on de novo SUP during their hospitalization on a surgical non-intensive care ward [25]. These findings clearly show that inappropriate SUP is still a critical issue in current surgical practice in Germany.…”