AB121. 75. The use of proton pump inhibitors in hip fracture patients

Background: Hip fractures represent a significant burden to every orthopaedic department. Patients with hip fractures are at risk of gastrointestinal stress ulceration. It is not common practice to prescribe prophylactic proton pump inhibitors (PPIs) to patients who are admitted with hip fractures. This may lead to an increased morbidity associated with gastrointestinal stress ulceration in this patient population.

Methods: A retrospective chart review of patients admitted with hip fractures to our department over 3-month period was performed. PPI usage, stress ulcer symptoms and complications, predisposing medications and length of stay were noted for each patient. The rates of stress ulcer symptoms and complications were compared between those patients taking PPI’s and those not taking PPIs.

Results: A total of 86 patients’ charts were reviewed: 35% were taking while 65% were not taking a PPI prior to admission. In total 10.5% experienced symptoms of stress ulceration. Of those taking a PPI 6.6% experienced symptoms. For those not on a PPI 12.5% experienced symptoms, 3 patients required an oesophagogastroduodenoscopy, 2 patients received blood and blood products, 1 patient required admission to the high dependency unit. All patients who suffered complications had lengths of stay in excess of the national average.

Conclusions: Patients with hip fractures are at an increased risk of stress induced ulceration and the concomitant complications. Limited data suggests those taking PPI therapy had a lower risk. Orthopaedic surgeons should be aware of these risks in assessing their patients. A randomised control trial due would determine best practice with regard to PPI use in this patient population.

Keywords: Hip fracture; proton pump inhibitor; stress ulceration