科研之友
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摘要
Study question
Do gastric acid suppressants increase the risk of postoperative pneumonia after elective surgery? Summary answer No, after adjustment for patient and surgical characteristics, acid suppressants are not associated with an increased risk of postoperative pneumonia among elderly patients admitted for elective surgery.
What is known and what this paper adds Postoperative pneumonia is a common and serious complication after major surgery, and use of gastric acid suppressants may increase patients' risk of pneumonia. This study found that patients who received gastric acid suppressants were at increased risk of postoperative pneumonia but were also predisposed to independent risk factors for postoperative pneumonia. Adjustment for these risk factors revealed no direct association between gastric acid suppressants and a patient's risk of postoperative pneumonia.
Participants and setting
Consecutive patients aged >65 years admitted for an elective operation to Canadian acute care hospitals between 1 April 1992 and 31 March 2008.
Design, size, duration
This population-wide, retrospective cohort analysis covered 16 years and included 593?265 patients.
Main results
About 21% of patients (n=121?850) were receiving an acid suppressant (most commonly omeprazole or ranitidine) and 79% (n=471?415) were not receiving an acid suppressant. The two groups were similar in mean age, fitness for surgery, and duration of surgery, but other risk factors for postoperative pneumonia were imbalanced against the acid suppressant group (including a history of chronic obstructive pulmonary disease, heart failure, Parkinson's disease, and prior pneumonia; nasogastric tubes; and prescriptions of antipsychotics). Overall, 6389 patients developed postoperative pneumonia, with a rate significantly higher for those taking acid suppressants (13 per 1000) than controls (10 per 1000), equivalent to a 30% increase in frequency (odds ratio 1.30 (95% confidence interval 1.23 to 1.38), P<0.001). However, after adjustment for duration of surgery, site of surgery, and other confounders, no increase in risk was observed (odds ratio 1.02 (0.96 to 1.09), P=0.48). The general safety of acid suppressants extended to those patients prescribed proton pump inhibitors (the most potent acid suppressants), experiencing long term treatment, receiving high doses, and undergoing high risk procedures. As expected, other factors were significant predictors of postoperative pneumonia (see table).
- 出版日期2010-6-21
