1
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Liu P, Li G, Wu Q, Han M, Zhang C. Analysis of inappropriate prophylactic use of proton pump inhibitors during the perioperative period: an observational study. Perioper Med (Lond) 2024; 13:19. [PMID: 38486296 PMCID: PMC10938722 DOI: 10.1186/s13741-024-00376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The prevalence and characteristics of inappropriate use of proton pump inhibitors (PPIs) to prevent stress-related mucosal disease (SRMD) during the perioperative period and its associated factors are rarely reported. This study aimed to investigate the prevalence and characteristics of inappropriate prophylactic use of proton pump inhibitors (PPIs) during the perioperative period and identify its associated factors in a tertiary care and academic teaching hospital in China and to provide evidence for regulation authorities and pharmacists to take targeted measures to promote rational drug use. METHODS Inpatients who underwent surgical operations and received prophylactic use of PPIs from June 2022 to November 2022 were included in this retrospective study. The appropriateness of perioperative prophylactic use of PPIs was evaluated by clinical pharmacists. Associated factors with inappropriate perioperative prophylactic use of PPIs were analyzed by univariable and multivariable logistic regression. RESULTS Four-hundred seventy-two patients were finally included in this study, of which 131 (27.75%) patients had at least one problem with inappropriate perioperative prophylactic use of PPIs. The three most common problems were drug use without indication (52.0%), inappropriate usage and dosage (34.6%), and inappropriate duration of medication (6.7%). Multiple logistic regression analysis showed that oral dosage form of PPIs [OR = 18.301, 95% CI (7.497, 44.671), p < 0.001], discharge medication of PPIs [OR = 11.739, 95% CI (1.289, 106.886), p = 0.029], and junior doctors [OR = 9.167, 95% CI (3.459, 24.299), p < 0.001] were associated with more inappropriate prophylactic use of PPIs. Antithrombotics [OR = 0.313, 95% CI (0.136, 0.721), p = 0.006] and prolonged postoperative hospital stay (longer than 15 days) [OR = 0.262, 95% CI (0.072, 0.951), p = 0.042] were associated with less inappropriate prophylactic use of PPIs. CONCLUSIONS The inappropriate prophylactic use of PPIs during the perioperative period is common. Regulation authorities and pharmacists should take more targeted measures to promote the rational prophylactic use of PPIs during the perioperative period.
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Affiliation(s)
- Pengpeng Liu
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Guangyao Li
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Qian Wu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mei Han
- Evidence-Based Medicine Center, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Zhang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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2
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Ruggiero C, Pioli G, Petruccelli R, Baroni M, Prampolini R, Pignedoli P, Antinolfi P, Rinonapoli G, Cappa M, Boccardi V, Bendini C, Mecocci P, Caraffa A, Sabetta E. The correlates of post-surgical haematoma in older adults with proximal femoral fractures. Aging Clin Exp Res 2023; 35:867-875. [PMID: 36773272 PMCID: PMC10115686 DOI: 10.1007/s40520-023-02354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/16/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Little is known about the incidence of haematoma, and clinical correlates among orthogeriatric patients. AIMS This study aims to describe the incidence of haematoma after surgical repair of hip fracture and to identify the clinical correlates of haematoma among orthogeriatric patients. METHODS Two orthopaedic surgeons and a dedicated operator using ultrasound technique, each other in blindness, evaluated 154 orthogeriatric patients during their hospital stay. All patients received a comprehensive geriatric assessment. We investigated the concordance between clinical diagnosis and ultrasound detection of haematoma, and then we explored the clinical correlates of the onset of post-surgical haematoma. RESULTS Blood effusion at the surgical site was detected in 77 (50%) patients using ultrasound technique; orthopaedic surgeons reached a clinical agreement about post-surgical haematoma in 18 (23%) patients. The sensitivity of clinical evaluation was 0.66, and the specificity was 0.70. Independent of age, clinical, pharmacological, and surgical confounders, proton pump inhibitors (PPIs) were associated with post-surgical haematoma (OR 2.28; 95% CI 1.15-4.49). A tendency towards association was observed between selective serotonin reuptake inhibitors and post-surgical haematoma (OR 2.10; 95% CI 0.97-4.54), CONCLUSIONS: Half of older patients undergoing surgical repair of proximal femoral fracture develop a post-surgical haematoma. Clinical assessment, even if made by senior orthopaedic surgeons, underestimates the actual occurrence of post-surgical haematoma compared to ultrasound detection. Ultrasound technique may help to detect haematoma larger than 15 mm better than clinical assessment. PPIs's use is a risk factor for post-surgical haematoma independent of several medical and surgical confounders.
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Affiliation(s)
- Carmelinda Ruggiero
- Orthogeriatric and Geriatric Unit, Department of Medicine and Surgery, Gerontology and Geriatric Section, S. Maria Misericordia Hospital, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - Giulio Pioli
- Orthogeriatric and Geriatric Unit, Department of Neuromotor Physiology and Rehabilitation, ASMN-IRCCS Hospital, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Rosario Petruccelli
- Orthopedic and Trauma Unit, Department of Medicine and Surgery, Orthopedic and Trauma Unit, Department of Medicine and Surgery, 06156, Perugia, Italy
| | - Marta Baroni
- Orthogeriatric and Geriatric Unit, Department of Medicine and Surgery, Gerontology and Geriatric Section, S. Maria Misericordia Hospital, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy
| | - Raffaella Prampolini
- Orthogeriatric and Geriatric Unit, Department of Neuromotor Physiology and Rehabilitation, ASMN-IRCCS Hospital, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Paolo Pignedoli
- Orthogeriatric and Geriatric Unit, Department of Neuromotor Physiology and Rehabilitation, ASMN-IRCCS Hospital, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Pierluigi Antinolfi
- Orthopedic and Trauma Unit, Department of Medicine and Surgery, Orthopedic and Trauma Unit, Department of Medicine and Surgery, 06156, Perugia, Italy
| | - Giuseppe Rinonapoli
- Orthopedic and Trauma Unit, Department of Medicine and Surgery, Orthopedic and Trauma Unit, Department of Medicine and Surgery, 06156, Perugia, Italy
| | - Michele Cappa
- Orthopaedic Unit, Department of Neuromotor Physiology and Rehabilitation, ASMN-IRCCS Hospital, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Virginia Boccardi
- Orthogeriatric and Geriatric Unit, Department of Medicine and Surgery, Gerontology and Geriatric Section, S. Maria Misericordia Hospital, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy
| | - Chiara Bendini
- Orthogeriatric and Geriatric Unit, Department of Neuromotor Physiology and Rehabilitation, ASMN-IRCCS Hospital, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Patrizia Mecocci
- Orthogeriatric and Geriatric Unit, Department of Medicine and Surgery, Gerontology and Geriatric Section, S. Maria Misericordia Hospital, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy
| | - Auro Caraffa
- Orthopedic and Trauma Unit, Department of Medicine and Surgery, Orthopedic and Trauma Unit, Department of Medicine and Surgery, 06156, Perugia, Italy
| | - Ettore Sabetta
- Orthopaedic Unit, Department of Neuromotor Physiology and Rehabilitation, ASMN-IRCCS Hospital, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
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3
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Meng SJ, Fan MQ, Qian JS, Zhang JW, Xu HH, Zheng Y, Zhao WQ, Shan LT, Huang JF. An Innovative Model of ISS-Based Multiple Fractures and Gastrointestinal Dysfunction Related to c-Kit Protein Expression on Interstitial Cells of Cajal. Orthop Surg 2023; 15:1325-1332. [PMID: 36919913 PMCID: PMC10157708 DOI: 10.1111/os.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/01/2022] [Accepted: 10/24/2022] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE Gastrointestinal dysfunction seriously affects the prognosis and quality of life of patients with multiple fractures. However, experimental evidence of this relationship is lacking. Here we describe a newly developed mouse model of postoperative gastrointestinal dysfunction after multiple fractures. METHODS Trauma severity was assessed using the injury severity score (ISS). Based on the ISS, a multiple fracture model was established in mice as follows: limb fractures with pelvic fractures and multiple rib fractures; limb fractures with multiple rib fractures; closed fracture of both forelegs with pelvic fracture and rib fractures; closed limb fractures; limb fracture with pelvic fracture; spinal fractures; hind leg fractures with pelvic fractures; pelvic fracture with multiple rib fractures; closed fracture of both fore legs with pelvic fracture; and closed fracture of both fore legs with multiple rib fractures. In each model group, gastrointestinal motility was assayed and the histopathology of the small intestine was examined. Western blot and immunohistochemical analyses of jejunal tissue were performed to detect c-kit protein expression, the level of which was compared with that of a control group. The results of ANOVA are expressed as mean ± standard deviation. RESULTS In mice with multiple fractures, food intake was greatly reduced, consistent with histopathological evidence of an injured intestinal epithelium. The jejunal tissue of mice in groups a, c, f, and h was characterized by extensively necrotic and exfoliated intestinal mucosal epithelium and inflammatory cell infiltration in the lamina propria. In the gastrointestinal function assay, gastrointestinal motility was significantly reduced in groups a, b, c, f, and g; these group also had a higher ISS (p < 0.01). The expression of c-kit protein in groups with gastrointestinal dysfunction was significantly up-regulated (p < 0.001) compared with the control group. The close correlation between c-kit expression and the ISS indicated an influence of trauma severity on gastrointestinal motility. CONCLUSION Gastrointestinal dysfunction after multiple fractures was successfully reproduced in a mouse model. In these mice, c-kit expression correlated with gastrointestinal tissue dysfunction and might serve as a therapeutic target.
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Affiliation(s)
- Shi-Jie Meng
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Meng-Qiang Fan
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian-Sheng Qian
- The Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing-Wen Zhang
- Research and Development Department, Cell Resource Bank and Integrated Cell Preparation Center of Xiaoshan District, Hangzhou, China
| | - Hui-Hui Xu
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yang Zheng
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei-Qiang Zhao
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Le-Tian Shan
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jie-Feng Huang
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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4
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Li H, Li N, Jia X, Zhai Y, Xue X, Qiao Y. Appropriateness and Associated Factors of Stress Ulcer Prophylaxis for Surgical Inpatients of Orthopedics Department in a Tertiary Hospital: A Cross-Sectional Study. Front Pharmacol 2022; 13:881063. [PMID: 35721126 PMCID: PMC9203048 DOI: 10.3389/fphar.2022.881063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/21/2022] [Indexed: 01/30/2023] Open
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.
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Affiliation(s)
- Haiyan Li
- Department of Pharmacy, Xi'an People's Hospital (Xi'an Fourth Hospital), The Affiliated Hospital of Northwestern Polytechnical University, Xi'an, China
| | - Ning Li
- Department of Pharmacy, Xi'an People's Hospital (Xi'an Fourth Hospital), The Affiliated Hospital of Northwestern Polytechnical University, Xi'an, China
| | - Xiaoni Jia
- Department of Science and Education, Xi'an Mental Health Center, Xi'an, China.,Department of Pharmacy, Xi'an Mental Health Center, Xi'an, China
| | - Yuyao Zhai
- Department of Pharmacy, Xi'an People's Hospital (Xi'an Fourth Hospital), The Affiliated Hospital of Northwestern Polytechnical University, Xi'an, China
| | - Xiaorong Xue
- Department of Pharmacy, Xi'an People's Hospital (Xi'an Fourth Hospital), The Affiliated Hospital of Northwestern Polytechnical University, Xi'an, China
| | - Yi Qiao
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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5
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Chuene MA, Pietrzak JRT, Sekeitto AR, Mokete L. Should we routinely prescribe proton pump inhibitors peri-operatively in elderly patients with hip fractures? A review of the literature. EFORT Open Rev 2021; 6:686-691. [PMID: 34532076 PMCID: PMC8419798 DOI: 10.1302/2058-5241.6.200053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Elderly hip fracture patients are at risk of stress-related gastric mucosal damage, and upper gastrointestinal bleeding is one of the underrecognized but devastating complications. Proton pump inhibitors (PPIs) offer effective prophylaxis against stress-related gastric mucosal damage. Systematic analysis of the literature revealed numerous articles on PPIs and hip fractures, but only three articles dedicated to the analysis of prophylactic use of PPIs in patients with a hip fracture. There is significant reduction in upper gastrointestinal bleeding following PPI prophylaxis and reduced 90-day mortality in elderly hip fracture patients on prophylaxis. PPIs are generally safe, cost-effective and based on available evidence. Their prophylactic use is justifiable in elderly patients with hip fractures. We suggest that PPIs be prescribed routinely peri-operatively in elderly hip fracture patients. Further level-one studies on the subject will allow for firmer recommendations.
Cite this article: EFORT Open Rev 2021;6:686-691. DOI: 10.1302/2058-5241.6.200053
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Affiliation(s)
- Mabua A Chuene
- Arthroplasty Unit, CMJAH, University of the Witwatersrand, Johannesburg, South Africa
| | - Jurek R T Pietrzak
- Arthroplasty Unit, CMJAH, University of the Witwatersrand, Johannesburg, South Africa
| | - Allan R Sekeitto
- Arthroplasty Unit, CMJAH, University of the Witwatersrand, Johannesburg, South Africa
| | - Lipalo Mokete
- Arthroplasty Unit, CMJAH, University of the Witwatersrand, Johannesburg, South Africa
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6
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Fernandez-Arroyabe N, García-Meléndez G, De Castro-Almeida AR, Escalona-Perez F, Pérez-Lara A, González-Quevedo D, García-Quevedo D, Tamimi I. Non-union and use of proton pump inhibitors in the treatment of femoral and tibial shaft fractures: a nested case-control study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1371-1377. [PMID: 34535805 DOI: 10.1007/s00590-021-03122-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/13/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are one of the most frequently used drugs worldwide. Previous research has shown that they could increase the risk of fracture and interfere with the fracture healing process. In this study, we analyzed the effect of PPIs on the risk of fracture non-union in patients with femoral and tibial shaft fractures. METHODS A case-control study was conducted at our institution, including a total of 254 patients who underwent fixation surgery for a femoral or tibial shaft fracture between January 2012 and December 2017. We defined cases as patients who experienced a delayed union (case group A; n = 44), or non-union (cases group B; n = 12). Cases were matched by age, sex, and fractured bone, to 144 controls who did not experience delayed fracture union and did not require further procedures. A conditional logistic regression analysis was performed adjusted to potential confounders, and to the proportion of days covered (PDC) with PPIs. RESULTS Adjusted ORs (95% CI) for undergoing a nail dynamization following a tibial or femoral shaft fracture were 1.38 (0.70-2.65) for any use PPIs. Patients with a longer PPI treatment courses (PDC ≥ 0.5) had an adjusted OR of 1.86 (0.70-4.76) for undergoing nail dynamization when compared with controls. Contrastingly, patients with a PDC < 0.5 had an adjusted OR of 1.03 (0.43-2.48). The adjusted OR (95% CI) for undergoing additional surgical procedures due to non-union was 4.5 (0.62-32.8) for any use of PPIs, and 12.3 (1.9-81.0) in patients with a PDC ≥ 0.5. CONCLUSIONS A prolonged use of PPIs use was associated with a higher risk of fracture non-union in tibial and femoral shaft fractures.
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Affiliation(s)
- Naiara Fernandez-Arroyabe
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Malaga, Carlos Haya Avenue, 29010, Malaga, Spain
| | - Gaspar García-Meléndez
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Malaga, Carlos Haya Avenue, 29010, Malaga, Spain
| | - Ana Raquel De Castro-Almeida
- Department of Radiodiagnostics, Regional University Hospital of Malaga, Carlos Haya Avenue, 29010, Malaga, Spain
| | - Francisca Escalona-Perez
- Department of Radiodiagnostics, Regional University Hospital of Malaga, Carlos Haya Avenue, 29010, Malaga, Spain
| | - Almudena Pérez-Lara
- Department of Radiodiagnostics, Regional University Hospital of Malaga, Carlos Haya Avenue, 29010, Malaga, Spain
| | - David González-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Malaga, Carlos Haya Avenue, 29010, Malaga, Spain
| | - David García-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Malaga, Carlos Haya Avenue, 29010, Malaga, Spain
| | - Iskandar Tamimi
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Malaga, Carlos Haya Avenue, 29010, Malaga, Spain.
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7
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Mester A, Apostu D, Ciobanu L, Piciu A, Lucaciu O, Campian RS, Taulescu M, Bran S. The impact of proton pump inhibitors on bone regeneration and implant osseointegration. Drug Metab Rev 2019; 51:330-339. [PMID: 31055956 DOI: 10.1080/03602532.2019.1610767] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Proton pump inhibitors (PPIs) have become known for the treatment of gastric-acid related disorders. Similar to any other drugs, PPIs have possible adverse reactions, being associated with bone fractures, infections, kidney disease, mineral deficiency, dementia, and pneumonia. Multiple analyses have stated that PPIs therapy may affect bone regeneration and osseointegration process, causing an increased risk of bone fracture, deterioration of bone metabolism and impaired bone healing. In this review, we emphasized the current literature regarding the influence of proton pump inhibitors in the bone regeneration process. Results from the studies suggest a link between PPIs intake and bone regeneration, but several concerns are raised regarding inadequate recipient bone, surgical trauma, limitations on the titanium surface, comorbidities or interference with other pharmacological agents. Further studies are needed to determine whether the impaired bone regeneration process is due to PPI or coexisting factors.
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Affiliation(s)
- Alexandru Mester
- Department of Oral Rehabilitation, Oral Health and Dental Office Management, University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
| | - Dragos Apostu
- Department of Orthopedics and Traumatology, University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
| | - Lidia Ciobanu
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
| | - Andra Piciu
- Department of Medical Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
| | - Ondine Lucaciu
- Department of Oral Rehabilitation, Oral Health and Dental Office Management, University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
| | - Radu Septimiu Campian
- Department of Oral Rehabilitation, Oral Health and Dental Office Management, University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
| | - Marian Taulescu
- Department of Pathology, University of Agricultural Sciences and Veterinary Medicine , Cluj-Napoca , Romania
| | - Simion Bran
- Department of Maxillofacial Surgery and Implantology, University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
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8
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Liu J, Gupta R, Hay K, Pulle C, Rahman T, Pandy S. Upper gastrointestinal bleeding in neck of femur fracture patients: a single tertiary centre experience. Intern Med J 2018; 48:731-735. [PMID: 29898280 DOI: 10.1111/imj.13809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 11/30/2022]
Abstract
This study aimed to identify the incidence of perioperative acute upper gastrointestinal bleeding (UGIB) in our hip fracture patients; to evaluate the characteristics, management and clinical outcomes of these patients; and to explore risk factors and protective factors. Of the 1691 consecutive patients admitted for surgical management of hip fractures, 11 (0.65%) had UGIB and a further four patients for each case were selected as controls for evaluation of risk factors and protective factors. Pre-existing peptic ulcer disease was identified as a risk factor for acute UGIB (odds ratio 7.9; 95% confidence interval: 1.1-54.9). This study reported a very low incidence of UGIB in hip fracture patients. Despite being a high-risk population, timely endoscopic evaluation can be safely undertaken to optimise patient outcome. When risk factors such as history of peptic ulcer disease are present, additional precaution including gastro-protective agent and nutritional support should be undertaken.
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Affiliation(s)
- Jessamine Liu
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Medicine and Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rohit Gupta
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Chrys Pulle
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tony Rahman
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Shaun Pandy
- Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
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9
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Brozek W, Reichardt B, Zwerina J, Dimai HP, Klaushofer K, Zwettler E. Use of proton pump inhibitors and mortality after hip fracture in a nationwide study. Osteoporos Int 2017; 28:1587-1595. [PMID: 28083667 DOI: 10.1007/s00198-017-3910-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 01/03/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED We analyzed the association of proton pump inhibitors (PPIs) with mortality after osteoporosis-related hip fracture in Austria. PPIs were associated with reduced 90-day mortality but elevated mortality after half a year when initiated pre-fracture. Inpatients and discharged patients on PPIs showed lowered in-hospital and 90-day mortality, respectively. INTRODUCTION We herein investigated use of proton pump inhibitors (PPIs) and mortality among hip fracture patients in a nationwide study in Austria. METHODS In this retrospective cohort study, data on use of PPIs were obtained from 31,668 Austrian patients ≥50 years with a hip fracture between July 2008 and December 2010. All-cause mortality in patients without anti-osteoporotic drug treatment who had received their first recorded PPI prescription in the study period either before or after fracture was compared with hip fracture patients on neither PPIs nor anti-osteoporotic medication using logistic and Cox regression analysis. RESULTS With PPI use, 90-day mortality was significantly reduced, both at initiation before (OR 0.66; p < 0.0001) and after hip fracture (OR 0.23; p < 0.0001). 90-day mortality was also reduced when PPIs were prescribed not until after discharge from the last recorded hip fracture-related hospital stay (OR 0.49; p < 0.0001) except for patients aged <70 years. In a sub-cohort of patients beginning PPIs during hospital stay, in-hospital mortality (0.2%) was substantially reduced relative to matched control patients (3.5%) (p < 0.0001). Longer-term mortality significantly increased after half a year post-fracture only among those who started PPI prescription before fracture. CONCLUSIONS PPI use during and after hospital stay due to hip fracture is associated with a considerable decrease in mortality. These findings could have implications for hip fracture treatment.
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Affiliation(s)
- W Brozek
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria.
| | - B Reichardt
- Sickness Fund Burgenland, Burgenländische Gebietskrankenkasse, Esterhazyplatz 3, 7000, Eisenstadt, Austria
| | - J Zwerina
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - K Klaushofer
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria
| | - E Zwettler
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria
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