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Noncompliance with guidelines on proton pump inhibitor prescription as gastroprotection in hospitalized surgical patients who are prescribed NSAIDs

van den Bemt, Patricia M.L.A.; Chaaouit, Naoual; van Lieshout, Esther M.M.; Verhofstad, Michael H.J.

European Journal of Gastroenterology & Hepatology: August 2016 - Volume 28 - Issue 8 - p 857–862
doi: 10.1097/MEG.0000000000000634
Original Articles: Gastro-oesophageal Disorders

Background and aims 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.

Materials and methods 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.

Results 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.

Conclusion Noncompliance with the guideline on NSAID use and gastroprotection is present in almost half of surgical hospital admissions and mainly involves overprescribing.

aDepartment of Hospital Pharmacy

bTrauma Research Unit, Erasmus University Medical Center, Rotterdam

cDepartment of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands

Correspondence to Patricia M.L.A. van den Bemt, PhD, Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands Tel: +31 107 033 202; fax: +31 107 032 400; e-mail:

Received December 22, 2015

Accepted February 25, 2016

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