Preoperative Proton Pump Inhibitor Use Was Associated With Increased Risk of Revision Surgery and Impaired Bone Healing After Pelvic Fracture Fixation: A Retrospective Cohort Study.

OBJECTIVES

The aim of this study was to evaluate the association between preoperative proton pump inhibitor (PPI) use and postoperative outcomes after pelvic fracture fixation.

DESIGN

Retrospective cohort study.

SETTING

TriNetX Research Network, a federated database of electronic medical records from approximately 103 health care organizations.

PATIENT SELECTION CRITERIA: Adult patients of 18 years of age and older who underwent surgical fixation of pelvic fractures between 2000 and 2023 were identified. All operatively managed pelvic fracture types were included, encompassing OTA/AO classifications 61 A-C; however, specific fracture classification was not available within the database. Patients were stratified into cohorts based on preoperative PPI use.

OUTCOME MEASURES AND COMPARISONS: Postoperative outcomes, including sepsis, revision surgery, hardware removal, nonunion, and malunion, were compared between patients with and without preoperative PPI use at 90 days and 2 years after surgery.

RESULTS

Before matching, 2648 patients were included in the preoperative PPI cohort and 7655 patients in the control cohort. After propensity score matching, 2403 patients remained in each cohort. The mean age was 44.0 ± 17.3 years in the PPI cohort and 43.7 ± 17.0 years in the control cohort, with 37.3% and 38.6% female patients, respectively. At 90 days postoperatively, preoperative PPI use was associated with increased risks of sepsis [risk ratio (RR) 1.48, 95% confidence interval (CI), 1.07-2.06, P = 0.017], deep vein thrombosis (RR 1.58, 95% CI, 1.11-2.23, P = 0.010), revision surgery (RR 1.69, 95% CI, 1.28-2.22, P < 0.001), and hardware removal (RR 1.58, 95% CI, 1.20-2.08, P < 0.001). At 2 years, preoperative PPI use remained associated with increased risk of revision surgery (RR 1.66, 95% CI, 1.27-2.15, P < 0.001), and nonunion (RR 1.71, 95% CI, 1.10-2.65, P = 0.015) and hardware removal (RR 1.17, 95% CI, 1.01-1.36, P = 0.039). No other significant differences were observed.

CONCLUSIONS

Preoperative PPI use was associated with increased risks of both short-term complications and long-term adverse outcomes after pelvic fracture fixation, including higher rates of sepsis, nonunion, malunion, and revision surgery.

LEVEL OF EVIDENCE: Level III, Prognostic.