JOT - 2026-05-05 - Journal Article
Preoperative Proton Pump Inhibitor Use Was Associated With Increased Risk of Revision Surgery and Impaired Bone Healing Following Pelvic Fracture Fixation: A Retrospective Cohort Study.
Wang J, McGowan E, Horani K, Hagedorn JC
Topics
Key Takeaway
Preoperative PPI use was associated with a 71% increased risk of nonunion (RR 1.71, 95% CI 1.10–2.65) and 66% increased risk of revision surgery (RR 1.66, 95% CI 1.27–2.15) at 2 years following pelvic fracture fixation.
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Summary
This study asked whether preoperative PPI use independently increases complication risk after operative pelvic fracture fixation using the TriNetX federated EMR database (2000–2023). After propensity score matching, PPI users had significantly higher 90-day rates of sepsis (RR 1.48), DVT (RR 1.58), revision surgery (RR 1.69), and hardware removal (RR 1.58). At 2 years, elevated risks persisted for revision surgery (RR 1.66), nonunion (RR 1.71), and hardware removal (RR 1.17).
Key Limitation
Absence of fracture classification data (OTA/AO 61A–C subtype, displacement, instability pattern) prevents controlling for injury severity, the most critical determinant of nonunion and revision risk in pelvic trauma.
Original Abstract
OBJECTIVES
To evaluate the association between preoperative proton pump inhibitor (PPI) use and postoperative outcomes following pelvic fracture fixation.
METHODS
Design: Retrospective cohort study.
SETTING
TriNetX Research Network, a federated database of electronic medical records from approximately 103 healthcare organizations.
PATIENT SELECTION CRITERIA
Adult patients aged 18 years 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 61A-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 following surgery.
RESULTS
Before matching, 2,648 patients were included in the preoperative PPI cohort and 7,655 patients in the control cohort. After propensity score matching, 2,403 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 (RR 1.48, 95% 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), as well as 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 following pelvic fracture fixation, including higher rates of sepsis, nonunion, malunion, and revision surgery.
LEVEL OF EVIDENCE
Level III, Prognostic.