van den Bemt Patricia M L A, Chaaouit Naoual, van Lieshout Esther M M, Verhofstad Michael H J
aDepartment of Hospital Pharmacy bTrauma Research Unit, Erasmus University Medical Center, Rotterdam cDepartment of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Eur J Gastroenterol Hepatol. 2016 Aug;28(8):857-62. doi: 10.1097/MEG.0000000000000634.
As NSAIDs can cause serious upper gastrointestinal harm, guidelines have been established for the prescribing of proton pump inhibitors (PPIs) in high-risk patients using NSAIDs. Studies examining guideline compliance in surgical patients are scarce. Therefore, a retrospective cross-sectional database study was carried out aimed at determining the proportion of noncompliance with the Dutch guideline and determining the association of several factors with this noncompliance.
Hospital admissions of patients on surgical wards of Erasmus University Medical Center between 1 January 2013 and 1 August 2014 were included in which an NSAID was newly prescribed. Preadmission PPI use was excluded. The main outcome was the proportion of noncompliance with the guideline. As a secondary outcome, the association of several potential risk factors with noncompliance was assessed. The proportion of guideline noncompliance was calculated as the percentage of all included surgical ward admissions. For the secondary analysis, univariate and multivariable logistic regression analyses were carried out.
A total of 409 admissions were included. The proportion of admissions in which guideline noncompliance was present was 46.6%, mostly because of incorrectly added PPIs. Coxib use [adjusted odds ratio 0.22 (95% confidence interval 0.12-0.44)], polypharmacy (the use of five or more drugs) [2.18 (1.27-3.76)], and the surgical wards orthopedics [22.32 (5.38-92.55)], plastic surgery [10.82 (2.51-46.59)], trauma surgery [5.78 (1.47-22.70)], and transplant/vascular surgery [4.45 (1.10-18.00)] were statistically significantly associated with noncompliance.
Noncompliance with the guideline on NSAID use and gastroprotection is present in almost half of surgical hospital admissions and mainly involves overprescribing.
由于非甾体抗炎药（NSAIDs）可导致严重的上消化道损害，已制定了针对使用NSAIDs的高危患者开具质子泵抑制剂（PPIs）的指南。针对外科手术患者的指南依从性研究较少。因此，开展了一项回顾性横断面数据库研究，旨在确定不遵守荷兰指南的比例，并确定若干因素与这种不依从性之间的关联。
纳入2013年1月1日至2014年8月1日期间在伊拉斯姆斯大学医学中心外科病房新开具NSAIDs的患者的住院病例。排除入院前使用PPI的情况。主要结局是不遵守指南的比例。作为次要结局，评估了若干潜在风险因素与不依从性之间的关联。指南不依从比例计算为所有纳入的外科病房住院病例的百分比。对于次要分析，进行了单变量和多变量逻辑回归分析。
共纳入409例住院病例。存在指南不依从情况的住院病例比例为46.6%，主要原因是PPI添加错误。使用昔布类药物[调整后的比值比为0.22（95%置信区间为0.12 - 0.44）]、联合用药（使用五种或更多药物）[2.18（1.27 - 3.76）]以及外科病房的骨科[22.32（5.38 - 92.55）]、整形外科[10.82（2.51 - 46.59）]、创伤外科[5.78（1.47 - 22.70）]和移植/血管外科[4.45（1.10 - 18.00）]与不依从性在统计学上显著相关。
几乎一半的外科住院病例存在不遵守NSAIDs使用和胃保护指南的情况，主要涉及过度开药。
