Perioperative acute upper gastrointestinal haemorrhage in older patients with hip fracture: incidence, risk factors and prevention.
BACKGROUND
No specific preventive strategy exists for acute gastrointestinal haemorrhage in hip fracture patients.


OBJECTIVE
To determine the effectiveness of prophylactic use of proton pump inhibitors in patients with risk factors for acute gastrointestinal haemorrhage.


METHODS
Prospective two-stage study of 822 consecutive older (> or =60 years) hip fracture patients.


RESULTS
Acute gastrointestinal haemorrhage occurred in 16 (3.9%) of 407 patients and was associated with increased length of hospital stay (28.7 vs. 15.9; P = 0.0027) and mortality (18.8% vs. 4.3%; P = 0.043). Multiple analysis identified five independent risk factors for acute gastrointestinal haemorrhage: pre-existing peptic ulcer (OR 4.3; P = 0.043), current smoking (OR 3.1; P = 0.023), post-operative use of an antiplatelet agent (OR 6.5; P = 0.046), post-operative use of non-steroidal anti-inflammatory drug/cyclo-oxygenase-2 inhibitor (OR 4.9; P = 0.06) and blood group O (OR 1.7; P = 0.046). These risk factors were highly sensitive and had a negative predictive value of 99.8%. Prophylactic use of proton pump inhibitors in patients with risk factor for acute gastrointestinal haemorrhage significantly reduced the incidence of this complication (0.72% in treated patients vs. 13.4% in untreated; P < 0.001); the number needed to treat was 7.9. Conclusions In older hip fracture patients perioperative acute gastrointestinal haemorrhage occurs in 3.9% and is associated with poor outcome. Preventive proton pump inhibitor therapy in patients at risk of acute gastrointestinal haemorrhage is effective and safe.
Fisher
L
L
Department of Gastroenterology, The Canberra Hospital, ACT, Australia. leonfisher@optusnet.com.au
Fisher
A
A
Pavli
P
P
Davis
M
M
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D008297:Male; D011300:Preoperative Care; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors
D054328:Proton Pump Inhibitors; D017494:Proton Pumps