Abstract：
BACKGROUND: Most patients undergoing anti-reflux surgery (ARS) have a history of preoperative proton pump inhibitor (PPI) use. It is well-established that ARS is effective in restoring the anti-reflux barrier, eliminating the ongoing need for costly PPIs. Current literature lacks objective evidence supporting an optimal postoperative PPI cessation or weaning strategy, leading to wide practice variations. We sought to objectively gauge current practice and opinion surrounding the postoperative management of PPIs among expert foregut surgeons and gastroenterologists in the United States.
METHODS: We created a survey of postoperative PPI management protocols, with an emphasis on discontinuation and timing of PPI cessation, and aimed to determine what factors played a role in the decision-making. An electronic survey tool (Qualtrics XM, Qualtrics, Provo, UT) was used to distribute the survey and to record the responses anonymously for a period of three months.
RESULTS: The survey was viewed 2658 times by 373 institutions and shared with 644 members. In total, 121 respondents participated in the survey and 111 were surgeons (92%). Fifty respondents (42%) always discontinue PPIs immediately after ARS. Of the remaining 70 respondents (58%), 46% always wean or taper PPIs postoperatively and 47% wean or taper them selectively. The majority (92%) of practitioners taper within a 3-month period postoperatively. Five respondents never discontinue PPIs after ARS. Overall, only 23 respondents (19%) stated their protocol is based on medical literature or evidence-based medicine. Instead, decision-making is primarily based on anecdotal evidence/personal preference (42%, n = 50) or prior training/mentors (39%, n = 47).
CONCLUSIONS: There are two major protocols used for PPI discontinuation after ARS: Nearly half of providers abruptly stop PPIs, while just over half gradually tapers them, most often in the early postoperative period. These decisions are primarily driven by institutional practices and personal preferences, underscoring the need for evidence-based recommendations.
METHODS: We created a survey of postoperative PPI management protocols, with an emphasis on discontinuation and timing of PPI cessation, and aimed to determine what factors played a role in the decision-making. An electronic survey tool (Qualtrics XM, Qualtrics, Provo, UT) was used to distribute the survey and to record the responses anonymously for a period of three months.
RESULTS: The survey was viewed 2658 times by 373 institutions and shared with 644 members. In total, 121 respondents participated in the survey and 111 were surgeons (92%). Fifty respondents (42%) always discontinue PPIs immediately after ARS. Of the remaining 70 respondents (58%), 46% always wean or taper PPIs postoperatively and 47% wean or taper them selectively. The majority (92%) of practitioners taper within a 3-month period postoperatively. Five respondents never discontinue PPIs after ARS. Overall, only 23 respondents (19%) stated their protocol is based on medical literature or evidence-based medicine. Instead, decision-making is primarily based on anecdotal evidence/personal preference (42%, n = 50) or prior training/mentors (39%, n = 47).
CONCLUSIONS: There are two major protocols used for PPI discontinuation after ARS: Nearly half of providers abruptly stop PPIs, while just over half gradually tapers them, most often in the early postoperative period. These decisions are primarily driven by institutional practices and personal preferences, underscoring the need for evidence-based recommendations.
摘要：
背景：大多数接受抗反流手术（ARS）的患者都有术前使用质子泵抑制剂（PPI）的病史。众所周知，ARS在恢复抗反流屏障方面是有效的，消除了对昂贵的PPI的持续需求。目前的文献缺乏支持最佳术后PPI停止或断奶策略的客观证据。导致广泛的实践差异。我们试图客观地评估美国专家前肠外科医生和胃肠病学家围绕PPI术后管理的当前实践和观点。
方法：我们创建了一项关于术后PPI管理方案的调查，强调停止PPI和停止PPI的时机，并旨在确定哪些因素在决策中发挥作用。一种电子调查工具(QualtricsXM，Qualtrics,普罗沃,UT）用于分发调查并匿名记录三个月的答复。
结果：该调查被373家机构查看了2658次，并与644名成员共享。总的来说,121名受访者参与了调查，111名是外科医生（92%）。50名受访者(42%)总是在ARS后立即停止PPI。其余70名受访者（58%）中，46％的人总是在术后断奶或逐渐变细PPI，47％的人选择性地断奶或逐渐变细。大多数（92％）的从业者在术后3个月内逐渐减少。五名受访者在ARS之后从未停止PPI。总的来说,只有23名受访者(19%)表示他们的方案基于医学文献或循证医学.相反，决策主要基于轶事证据/个人偏好(42%，n=50)或先前的培训/导师(39%，n=47）。
结论：ARS后停用PPI有两种主要方案：近一半的提供者突然停用PPI，而刚刚超过一半的人逐渐变细，通常在术后早期。这些决定主要是由机构实践和个人偏好驱动的，强调需要以证据为基础的建议。
方法：我们创建了一项关于术后PPI管理方案的调查，强调停止PPI和停止PPI的时机，并旨在确定哪些因素在决策中发挥作用。一种电子调查工具(QualtricsXM，Qualtrics,普罗沃,UT）用于分发调查并匿名记录三个月的答复。
结果：该调查被373家机构查看了2658次，并与644名成员共享。总的来说,121名受访者参与了调查，111名是外科医生（92%）。50名受访者(42%)总是在ARS后立即停止PPI。其余70名受访者（58%）中，46％的人总是在术后断奶或逐渐变细PPI，47％的人选择性地断奶或逐渐变细。大多数（92％）的从业者在术后3个月内逐渐减少。五名受访者在ARS之后从未停止PPI。总的来说,只有23名受访者(19%)表示他们的方案基于医学文献或循证医学.相反，决策主要基于轶事证据/个人偏好(42%，n=50)或先前的培训/导师(39%，n=47）。
结论：ARS后停用PPI有两种主要方案：近一半的提供者突然停用PPI，而刚刚超过一半的人逐渐变细，通常在术后早期。这些决定主要是由机构实践和个人偏好驱动的，强调需要以证据为基础的建议。
