82. Comparison of postoperative proton pump inhibitors vs histamine H2-receptor antagonists use on complication rates following Multilevel lumbar fusions

Abstract

BACKGROUND CONTEXT

Proton pump inhibitors (PPIs) are commonly used both perioperatively and postoperatively to prevent gastrointestinal complications, but their long-term use is associated with adverse effects, such as an increased risk of fractures, which is particularly concerning for spinal surgery patients. Some studies suggest that PPIs may also raise the risk of pseudarthrosis in cervical spine fusions. In contrast, Histamine H2-receptor antagonists (H2 blockers) may offer a better safety profile and even support bone health. Despite this, their impact on postoperative complications following multi-level lumbar fusion surgeries remains unclear.

PURPOSE

This study aims to compare the 90-day and two-year complication rates between postoperative PPI therapy and postoperative H2 antagonist therapy in patients undergoing multi-level lumbar fusion, with a particular focus on complications related to bone healing, fusion success, and overall recovery outcomes.

STUDY DESIGN/SETTING

Retrospective cohort study using data from TriNetX, a comprehensive healthcare database that includes patients from 2010 to 2024.

PATIENT SAMPLE

N/A

OUTCOME MEASURES

N/A

METHODS

Patients who underwent multi-level lumbar fusion surgery within the TriNetX database were identified, excluding those with prior PPI or H2 blocker use. The cohort was divided into two groups: those who received PPIs and those who received H2 blockers postoperatively. A 1:1 propensity score matching was applied to control for confounders such as age, sex, and comorbidities, resulting in 3,712 patients per group. Logistic regression was used to calculate risk ratios (RRs) for complications at 90 days and 2 years post-surgery.

RESULTS

At 90 days, the PPI group showed significantly higher rates of mortality (1.91% vs 1.19%, RR = 1.634, 95% CI = 1.111–2.374, P = 0.011) and pneumonia (2.72% vs 1.83%, RR = 1.501, 95% CI = 1.096–2.053, P = 0.010). Acute kidney injury (4.01% vs 2.96%, RR = 1.368, 95% CI = 1.072–1.756, P = 0.014), myocardial infarction (1.40% vs 0.84%, RR = 1.687, 95% CI = 1.078–2.641, P = 0.020), and urinary tract infections (5.66% vs 4.34%, RR = 1.320, 95% CI = 1.068–1.629, P = 0.009) were also more common in the PPI group. Additionally, the PPI group had a higher risk of dural tear (0.67% vs 0.27%, RR = 2.509, 95% CI = 1.202–5.228, P = 0.011). At 2 years, the PPI group had higher rates of reoperation (8.07% vs 6.48%, RR = 1.245, 95% CI = 1.057–1.466, P = 0.008), pseudarthrosis (16.33% vs 13.20%, RR = 1.227, 95% CI = 1.101–1.367, P = 0.000), and pedicle loosening (7.96% vs 6.00%, RR = 1.327, 95% CI = 1.122–1.570, P = 0.001).

CONCLUSIONS

Postoperative PPI therapy is associated with higher complication rates in both the short and long term compared to H2 blockers. Specifically, PPI use leads to higher risks of mortality, pneumonia, acute kidney injury, myocardial infarction, urinary tract infections, and dural tears shortly after surgery. At two years, the PPI group also shows higher rates of reoperation, pseudarthrosis, and pedicle loosening. These findings suggest that H2 blockers may be a safer postoperative option to improve bone healing and reduce long-term complications. Clinicians should consider this evidence when selecting perioperative and postoperative treatments to enhance recovery and minimize adverse outcomes, particularly in patients at risk for poor bone healing or long-term complications.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.