Stress Ulcer Prophylaxis in Orthopaedic Surgery.

Area of Science:

• Gastroenterology
• Orthopaedic Surgery
• Critical Care Medicine

Background:

• Stress-related gastrointestinal complications, including perforated peptic ulcer (PPU) and upper gastrointestinal bleeding, can cause significant morbidity and mortality post-orthopaedic surgery.
• The use of stress ulcer prophylaxis (SUP) is common in critical care but its application in orthopaedic surgery is not well-defined.

Purpose of the Study:

• To review the incidence and risk factors of stress-related gastrointestinal complications after orthopaedic surgery.
• To evaluate the role and recommendations for stress ulcer prophylaxis in orthopaedic surgical patients.

Main Methods:

• A narrative literature review was conducted.
• Data on the incidence of PPU, associated mortality, and risk factors were analyzed.
• Current guidelines and evidence for SUP in critically ill patients were examined.

Main Results:

• The incidence of PPU after orthopaedic procedures is low (0.054% after elective spine surgery), but mortality can be as high as 25%.
• Risk factors for PPU include NSAID use, advanced age, comorbidities, and critical illness.
• SUP has demonstrated efficacy in reducing gastrointestinal bleeding in critically ill patients.

Conclusions:

• Orthopaedic surgeons should consider SUP selectively for high-risk patients, balancing potential benefits against risks.
• Routine SUP is not recommended for all orthopaedic surgical patients.
• Tailoring prophylaxis to individual patient risk factors is crucial for preventing complications.