Type of stress ulcer prophylaxis and risk of nosocomial pneumonia in cardiac surgical patients: cohort study.
OBJECTIVE
To examine the relation between the type of stress ulcer prophylaxis administered and the risk of postoperative pneumonia in patients undergoing coronary artery bypass grafting.


METHODS
Retrospective cohort study.


METHODS
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METHODS
21,214 patients undergoing coronary artery bypass graft surgery between 2004 and 2010; 9830 (46.3%) started proton pump inhibitors and 11,384 (53.7%) started H2 receptor antagonists in the immediate postoperative period.


METHODS
Occurrence of postoperative pneumonia, assessed using appropriate diagnostic codes.


RESULTS
Overall, 492 (5.0%) of the 9830 patients receiving a proton pump inhibitor and 487 (4.3%) of the 11,384 patients receiving an H2 receptor antagonist developed postoperative pneumonia during the index hospital admission. After propensity score adjustment, an elevated risk of pneumonia associated with treatment with proton pump inhibitors compared with H2 receptor antagonists remained (relative risk 1.19, 95% confidence interval 1.03 to 1.38). In the instrumental variable analysis, use of a proton pump inhibitor (compared with an H2 receptor antagonist) was associated with an increased risk of pneumonia of 8.2 (95% confidence interval 0.5 to 15.9) cases per 1000 patients.


CONCLUSIONS
Patients treated with proton pump inhibitors for stress ulcer had a small increase in the risk of postoperative pneumonia compared with patients treated with H2 receptor antagonists; this risk remained after confounding was accounted for using multiple analytic approaches.
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Brian T
BT
Bateman
Katsiaryna
K
Bykov
Niteesh K
NK
Choudhry
Sebastian
S
Schneeweiss
Joshua J
JJ
Gagne
Jennifer M
JM
Polinski
Jessica M
JM
Franklin
Michael
M
Doherty
Michael A
MA
Fischer
Jeremy A
JA
Rassen
D000368:Aged; D000897:Anti-Ulcer Agents / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D006635:Histamine H2 Antagonists / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000517:prevention & control; D011014:Pneumonia / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013312:Stress, Physiological
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors