Postoperative pneumonia in elderly patients receiving acid suppressants: a retrospective cohort analysis.
OBJECTIVE
To test whether gastric acid suppressants are associated with an increased risk of postoperative pneumonia in patients undergoing elective surgery.


METHODS
Population-wide retrospective cohort analysis.


METHODS
Canadian acute care hospitals between 1 April 1992 and 31 March 2008. Patients Consecutive patients aged >65 years admitted for an elective operation.


METHODS
Postoperative pneumonia recorded in inpatient postoperative notes.


RESULTS
A total of 593 265 patients were included, of whom about 21% were taking an acid suppressant (most commonly omeprazole or ranitidine). Overall, 6389 patients developed postoperative pneumonia, with a rate significantly higher for those taking acid suppressants (13 per 1000) than controls (10 per 1000), equivalent to a 30% increase in frequency (odds ratio 1.30 (95% confidence interval 1.23 to 1.38), P<0.001). However, no increase in risk was observed after adjustment for duration of surgery, site of surgery, and other confounders (odds ratio 1.02 (0.96 to 1.09), P=0.48). The general safety of acid suppressants extended to those patients prescribed proton pump inhibitors, experiencing long term treatment, receiving high doses, and undergoing high risk procedures.


CONCLUSIONS
After adjustment for patient and surgical characteristics, acid suppressants are not associated with an increased risk of postoperative pneumonia among elderly patients admitted for elective surgery.
Redelmeier
Donald A
DA
Department of Medicine, University of Toronto, Toronto, Canada.
McAlister
Finlay A
FA
Kandel
Christopher E
CE
Lu
Hong
H
Daneman
Nick
N
D000368:Aged; D000863:Antacids / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D009853:Omeprazole / Q000009:adverse effects*; D011014:Pneumonia / Q000139:chemically induced*; D011183:Postoperative Complications / Q000139:chemically induced*; D011899:Ranitidine / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
D000863:Antacids; D011899:Ranitidine; D009853:Omeprazole