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

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.