was performed. Demographic, intraoperative and postoperative outcome data were recorded using electronic hospital administrative databases and linked to hospital and community based pharmacy prescription databases to assess duration of PPI therapy and associated medications (non steroidal anti inflammatory drugs(N-SAIDs), oral anticoagulants). The number of postoperative PPI prescription days was quantified and categorised into 6 monthly intervals. Univariate statistical analyses were then carried out to assess association between PPI duration with MU and UGI bleeding complications. Further assessment was also made of PPI prescription and outcome with a logistic regression model adjusted for standard demographic and perioperative factors. Analysis was with Stata v14 with the significance level set at p<0.05. Results: The mean age was 63.7years (SD 14) (52% male). Median follow up was 666 days (95%CI 606e72) and median postoperative stay 13 days (IQR 10 e 20). The major complication rate was 10.7%. The marginal ulceration rate was 3.1% (95% CI 1.5 e5.6%) and postoperative GI bleeding was 5% (95%CI 2.9e8%). Median time to development of GI bleeding / ulceration was 7.5 months (IQR 1e28 months). The in-hospital postoperative PPI prescription rate was 89%. In the community (post-discharge) the rate reduced to 68.4%. Adjusting for postoperative death during the same period; 50.8%, 41.3%, 27.8% of PD patients had prescribed PPI therapy for a minimum of 6 months, 1 year and 2 years respectively. Only 37% of patients were prescribed PPI therapy for greater than 50% of their follow-up period and only 13% of patients were prescribed PPI for the full duration of their follow-up period. Inpatient PPI therapy had no impact on in-hospital major complications (11.1% v 10.6% p = 0.93) and was associated with an increased hospital stay (12.2 days v 18.5 days p = 0.02). The prescription of postoperative PPI did not impact upon GI bleeding or marginal ulceration rates (2.5 v 3.3% p = 0.723 for MU and 2.5% v 5.8% p = 0.24 for GI bleed). When stratified by 6 monthly durations, PPI therapy had no impact on MU (OR 1.2 95%CI 0.8e1.8 p = 0.371). Total PPI use of between 6 months and 12months duration was associated an increased odds of GI bleeding (OR 1.4 1.1e1.97 p = 0.04). In a model adjusted for age, sex and NSAID use no association between PPI therapy duration and GI bleeding was observed (OR 1.37 95% CI 0.97e 1.94 p = 0.17). Conclusion: The pattern of postoperative PPI use amongst patients undergoing PD is variable, with only a third of patients using PPI therapy for the majority of their postoperative course. In-patient PPI therapy does not alter early postoperative complication rates. Longer term PPI use does not appear to reduce post PD gastrointestinal bleeding or marginal ulceration complications. This population based analysis of PPI use has demonstrated a lack of efficacy for routine PPI prescription in preventing marginal ulceration and upper gastro intestinal bleeding complications following pancreaticoduodenectomy. The rou...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.