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Prophylactic use of proton pump inhibitors post-cardiac surgery
Matthew Azzopardi1, Jean-Luc Paris1, David Sladden1
1Cardiothoracic Surgery Department, Mater Dei Hospital, Imsida, Malta.
Insights
Implementing a simple intervention significantly improved proton pump inhibitor use after cardiac surgery, leading to fewer gastrointestinal bleeds. This highlights the importance of standardized prescribing for patient safety.
Area of Science:
- Cardiology
- Gastroenterology
- Surgical Outcomes
Background:
- Gastrointestinal bleeding is a significant complication after cardiac surgery, increasing patient morbidity and mortality.
- Proton pump inhibitors (PPIs) are recommended prophylactically by the European Association of Cardio-Thoracic Surgery (Class IIa).
Purpose of the Study:
- To evaluate the impact of a simple intervention on postoperative PPI prescribing rates.
- To assess the effect of improved PPI use on gastrointestinal bleeding incidence post-cardiac surgery.
Main Methods:
- Retrospective review of cardiac surgery patients (July-December 2019).
- Introduction of treatment charts with pre-printed PPIs in the regular medication section.
- Two subsequent reaudits using the same methodology to assess changes.
Main Results:
- Postoperative omeprazole prescription increased significantly from 47% pre-intervention to 74% (first reaudit) and 66% (second reaudit).
- Gastrointestinal bleeding incidence decreased from 4% pre-intervention to 1% post-intervention, though not statistically significant (P=0.10).
Conclusions:
- The intervention successfully improved the rate of postoperative omeprazole prescription.
- While gastrointestinal bleeds decreased, other factors like comorbidities (diabetes, arteriosclerosis) and procedure urgency may have influenced statistical significance.
Aims/Background:
Gastrointestinal bleeding significantly increases morbidity and mortality rates postoperatively in patients undergoing cardiac surgery. The prophylactic prescribing of proton pump inhibitors post-cardiac surgery is currently a class IIa recommendation of the European Association of Cardio-Thoracic Surgery.
Method:
A retrospective review of patients who underwent cardiac surgery between July and December 2019 in the authors' hospital was carried out, using discharge summaries. New treatment charts were introduced with a pre-printed proton pump inhibitor included in the 'regular medication' section of the treatment chart and two reaudits were performed using the same methodology.
Results:
Before the intervention, 47% were prescribed omeprazole postoperatively, compared to 74% (P<0.001) and 66% (P=0.008) in the first and second reaudits respectively. Gastrointestinal bleeding was more common pre-intervention (4% vs 1% respectively; P=0.10).
Conclusions:
This intervention resulted in a statistically significant improvement in the prescription of postoperative omeprazole and a decrease in gastrointestinal bleeds. However, other risk factors such as diabetes mellitus, arteriosclerosis and procedure urgency may have contributed to the absence of statistical significance in the latter.
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