Validity and Execution of Stress Ulcer Prophylaxis in Surgical Patients: A Single-Center, Retrospective Cohort Analysis in Islamabad, Pakistan

Abstract

Introduction: Stress ulcer prophylaxis (SUP) is recommended in critically ill patients to prevent stress-related mucosal damage, however, there is inconsistent adherence to established standards and guidelines for those who receive SUP medications outside of this patient group. The present study aimed to evaluate the appropriateness of SUP medications for surgical patients at the tertiary care hospital in Islamabad, Pakistan.
Methodology: A 1-year, retrospective cohort study was conducted, using a convenience sampling approach, involving patients undergoing surgical procedures at the Surgical Wards of a tertiary care hospital located in Islamabad. Data collection was performed using a pre-designed checklist, with main areas including demographic characteristics, data on their presenting complaint, SUP medications (dosage, route of administration and duration) and presence of stress ulcer risk factors.
Results: n=418 patient records were assessed: the majority of the patients were female (62.6%; n=262), with a mean age was 53.6±11.7 years, treated at the General Surgery department (81.8%; n=342). All patients managed for SUP were prescribed PPIs; the most commonly used PPI was omeprazole, both orally (37.7%; n=158) and parenterally (39.7%; n=166). The majority of patients (72.2%; n=302) were prescribed SUP for an appropriate indication or an associated risk. 46.1% (n=193) received SUP as a discharge medication with no records showing a follow-up, and there was no clear evidence that suggested that SUP had been stopped.
Conclusions: This study highlights the irrational prescribing of PPIs in non-critical patients and the improper continuing of PPI prescriptions after discharge in a real-world setting, indicating the need to address suggested protocols for rationalizing the use of SUP and limiting the use of PPIs for appropriate purposes.