Perioperative proton pump inhibitors use and postoperative surgical complications following primary total shoulder arthroplasty.

BACKGROUND: Proton pump inhibitors (PPIs) are commonly used perioperatively, but their effect on postoperative total shoulder arthroplasty (TSA) outcomes is unclear. The purpose of this study is to determine the effects of perioperative PPIs on surgical complications following primary TSA.

METHODS: A retrospective cohort study using TriNetX identified patients undergoing TSA using CPT code 23472. The exposure cohort included patients prescribed a perioperative PPI from seven days preoperatively to two days postoperatively and underwent propensity score matching 1:1 to its nearest neighbor. Surgical outcomes were studied at 3 years. Risk ratios (RRs), 95% confidence intervals (CIs), and p-values were reported. Statistical significance was set at p < 0.05.

RESULTS: At 3 years postoperatively, PPI cohort had increased rates of aseptic loosening (1.3% vs. 0.7%; RR 1.9; 95% CI 1.0, 3.6; p = 0.034), dislocation (2.3% vs. 1.3%; RR 1.7; 95% CI 1.1, 2.7; p = 0.017), and revision TSA (3.0% vs. 2.0%; RR 1.5; 95% CI 1.0, 2.2; p = 0.031), and overall complications (5.7% vs. 4.3%; RR 1.3; 95% CI 1.0, 1.7; p = 0.043) compared to matched controls.

CONCLUSION: Perioperative PPI use was associated with increased rates of aseptic loosening, dislocation, and revision TSA through 3 years following primary TSA, suggesting PPI exposure may be an important preoperative risk factor.

LEVEL OF EVIDENCE: Level III-Retrospective cohort study.