西安市三级医疗机构骨科围术期预防性使用抑酸剂的合理性及影响因素研究

目的:调查西安市9家三级医院骨科围术期使用抑酸剂预防应激性溃疡的合理性及影响因素.方法:采用回顾性病历查阅,随机抽取9家医院2019年7-12月骨科骨折相关手术患者病例共计900份,统计患者基本信息及病例资料等,评价抑酸剂预防性使用的合理性.结果:900例手术患者中,692例(76.89％)于围术期预防性使用抑酸药...

Appropriateness and influencing factors of prophylactic use of antisecretory agents during perioperative period of orthopedics surgery patients from nine tertiary hospitals in Xi'an

OBJECTIVE To explore the appropriateness and influencing factors of antisecretory agents prophylactic prescription during perioperative period of orthopedics from 9 tertiary hospitals in Xi'an.METHODS The retrospective medical records of 900 orthopedic patients undergoing fracture-related surgery were selected from July to December 2019 through 9 tertiary hospital in HIS system to analyze the dosing rationality of antacids. Influencing factors were examined by Logistic regression analysis.RESULTS Among 900 surgical patients, 692 patients (76.89%) received antisecretory agents for stress ulcer prophylaxis (SUP), 646 (93.35%) PPIs and 394(43.77%) antisecretory agents without recognized indications (overprescribing). The incidence of inappropriate usage of PPIs was 51.61 per 100 patient-days (n=1 616 total patient-days). Sixty-two patients (6.89%) were not prescribed antisecretory agents despite the presence of recognized indications (underprescribing). The proportion of patients with postoperative medication was 81.94% and the proportion of patients with medication course >3 days 41.04%. Overprescribing of antisecretory agents was independently correlated with overall comorbidities (OR=1.233, 95%CI:1.016-1.496) and negatively associated with use of systemic corticosteroids (OR=0.270, 95%CI:0.185-0.394). Conversely, underprescribing of antisecretory agents was independently correlated with the number of in-hospital days (OR=1.075, 95%CI:1.007-1.149), use of systemic corticosteroids (OR=17.924, 95%CI:2.826-113.695) and anticoagulants (OR=3.260, 95%CI:1.366-7.778), and negatively associated with female (OR=0.172, 95%CI:0.062-0.476), occupation (OR=0.224, 95%CI:0.075-0.671) and number of drugs excluding PPIs (OR=0.923, 95%CI:0.854-0.998).CONCLUSION There are some outstanding problems in perioperative prophylactic use of PPI in orthopedics, such as not following the recommended indications, inappropriate dosing time and long course of treatment in some cases. Clinicians should pay great attention to the rational application of antisecretory agents during perioperative period of orthopedics. Pharmacists should highlight the need of interventions for optimize the prescribing of PPIs for SUP.