Proton pump inhibitors are associated with increased risk of pseudoarthrosis after lumbar fusion

Pseudoarthrosis is a major complication following lumbar spine fusion, leading to revision surgery, increased disability, and substantial economic burden. Proton pump inhibitors (PPIs) are commonly used in the perioperative period, but their impact on fusion success remains poorly defined.

This retrospective cohort study utilized the TriNetX research database to identify adult patients undergoing lumbar spine fusion. Patients were divided into 2 cohorts based on documented PPI use within 30 days postoperatively and underwent 1:1 propensity score matching based on demographic and clinical characteristics. The incidence of pseudoarthrosis was assessed using diagnostic coding, and risk was compared using risk ratios and Kaplan-Meier survival analysis. An age-stratified analysis was also performed.

A total of 122,584 matched pairs were analyzed. Pseudoarthrosis occurred in 7.38% of PPI users compared to 3.98% of nonusers (RR: 1.88; p < .0001). Kaplan-Meier survival analysis revealed early separation of pseudoarthrosis-free survival curves by postoperative day 60, persisting through 1-year follow-up. Age-stratified analysis showed consistently higher pseudoarthrosis risk among PPI users across all age groups, with the largest relative impact observed in patients under 55 years old.

Postoperative PPI use is associated with a significantly increased risk of pseudoarthrosis following lumbar spine fusion. These findings suggest careful consideration of the necessity of PPI therapy in the perioperative period, particularly in younger patients where the relative impact appears the greatest.