Is acid suppression associated with postoperative pneumonia?

January 01, 0001

Is acid suppression associated with postoperative pneumonia?

These Canadian investigators examined whether gastric acid suppressants are associated with increased risk of postoperative pneumonia. They performed a population-wide retrospective cohort analysis looking at patients over 65 years of age undergoing an elective surgery.

The authors report: "A total of 593,65 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. However, no increase in risk was observed after adjustment for duration of surgery, site of surgery, and other confounders (odds ratio 1.02). 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."

The authors concluded: "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."

This large retrospective study finds no evidence that acid suppression therapy poses an increased risk of postoperative pneumonia.

For the full abstract, click here.

BMJ 340:c2608, 21 June 2010
© 2010 Redelmeier et al.
Postoperative pneumonia in elderly patients receiving acid suppressants: a retrospective cohort analysis. Donald A Redelmeier, Finlay A McAlister, Christopher E Kandel, Hong Lu, Nick Daneman. Correspondence to D A Redelmeier: [email protected]

Category: D. Digestive, R. Respiratory. Keywords: pneumonia, postoperative, acid suppression, PPIs, H2 blockers, retrospective cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 30 July 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.