Pre-operative proton pump inhibitor use is associated with increased post-operative complications following anatomic total shoulder arthroplasty
- 1Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- 2Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
- 3Department of Surgery, Hoag Orthopedics Institute, Irvine, CA, USA
Abstract
Background: Proton pump inhibitors (PPIs) are frequently prescribed in the perioperative setting for gastrointestinal prophylaxis. However, emerging evidence suggests that pre-operative PPI exposure may influence post-operative outcomes through effects on host immune function, nutritional status, and bone metabolism. The purpose of this study was to evaluate the association between pre-operative PPI use and post-operative complications following anatomic total shoulder arthroplasty.
Methods: A retrospective cohort study was performed using the TriNetX US Collaborative Network. Adult patients undergoing primary anatomic TSA between 2005 and 2023 were stratified by pre-operative PPI use. Patients with a history of gastrointestinal bleeding were excluded. Propensity score matching was performed for demographic characteristics, modified frailty index variables, additional comorbidities, medications, and body mass index, yielding 7,075 patients per cohort. Ninety-day medical and 1-year and 2-year surgical complications were compared using risk ratios (RRs) with 95% confidence intervals.
Results: Within 90 days, PPI exposure was associated with increased risks of readmission and acute kidney injury. Rates of emergency department utilization were also higher among patients receiving PPIs, whereas differences in pneumonia, pulmonary embolism, deep vein thrombosis, post-operative infection, and stroke did not reach statistical significance. At 1 year, perioperative PPI use was associated with significantly higher rates of periprosthetic joint infection (1.7% vs. 1.2%; RR, 1.45; P = .008), dislocation (2.0% vs. 1.5%; RR, 1.33; P = .027), aseptic loosening (0.8% vs. 0.4%; RR, 1.71; P = .016), and mortality (1.2% vs. 0.9%; RR, 1.40; P = .044). At 2 years, PPI use remained associated with increased rates of periprosthetic joint infection (2.4% vs. 1.6%; RR, 1.52; P < .001) and mortality (2.5% vs. 1.7%; RR, 1.48; P = .001). No significant differences were observed in revision arthroplasty, periprosthetic fracture, dislocation, or aseptic loosening at 2 years.
Conclusion: Pre-operative PPI use following TSA was associated with increased early medical complications and higher rates of implant-related complications at midterm follow-up. These findings highlight the importance of careful medication review and risk stratification in patients undergoing anatomic TSA.
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BibTeX
@article{ilyas2026preoperative,
title = {{Pre-operative proton pump inhibitor use is associated with increased post-operative complications following anatomic total shoulder arthroplasty}},
author = {Muhammad Hamza Ilyas and Joseph A. Abboud and Hafiz F. Kassam},
journal = {Journal of Shoulder and Elbow Arthroplasty},
year = {2026},
month = sep,
doi = {10.1016/j.jsea.2026.100102},
url = {https://doi.org/10.1016/j.jsea.2026.100102},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Pre-operative proton pump inhibitor use is associated with increased post-operative complications following anatomic total shoulder arthroplasty
AU - Muhammad Hamza Ilyas
AU - Joseph A. Abboud
AU - Hafiz F. Kassam
PY - 2026
DA - 2026/09/29
JO - Journal of Shoulder and Elbow Arthroplasty
DO - 10.1016/j.jsea.2026.100102
UR - https://doi.org/10.1016/j.jsea.2026.100102
AB - Background: Proton pump inhibitors (PPIs) are frequently prescribed in the perioperative setting for gastrointestinal prophylaxis. However, emerging evidence suggests that pre-operative PPI exposure may influence post-operative outcomes through effects on host immune function, nutritional status, and bone metabolism. The purpose of this study was to evaluate the association between pre-operative PPI use and post-operative complications following anatomic total shoulder arthroplasty. Methods: A retrospective cohort study was performed using the TriNetX US Collaborative Network. Adult patients undergoing primary anatomic TSA between 2005 and 2023 were stratified by pre-operative PPI use. Patients with a history of gastrointestinal bleeding were excluded. Propensity score matching was performed for demographic characteristics, modified frailty index variables, additional comorbidities, medications, and body mass index, yielding 7,075 patients per cohort. Ninety-day medical and 1-year and 2-year surgical complications were compared using risk ratios (RRs) with 95% confidence intervals. Results: Within 90 days, PPI exposure was associated with increased risks of readmission and acute kidney injury. Rates of emergency department utilization were also higher among patients receiving PPIs, whereas differences in pneumonia, pulmonary embolism, deep vein thrombosis, post-operative infection, and stroke did not reach statistical significance. At 1 year, perioperative PPI use was associated with significantly higher rates of periprosthetic joint infection (1.7% vs. 1.2%; RR, 1.45; P = .008), dislocation (2.0% vs. 1.5%; RR, 1.33; P = .027), aseptic loosening (0.8% vs. 0.4%; RR, 1.71; P = .016), and mortality (1.2% vs. 0.9%; RR, 1.40; P = .044). At 2 years, PPI use remained associated with increased rates of periprosthetic joint infection (2.4% vs. 1.6%; RR, 1.52; P < .001) and mortality (2.5% vs. 1.7%; RR, 1.48; P = .001). No significant differences were observed in revision arthroplasty, periprosthetic fracture, dislocation, or aseptic loosening at 2 years. Conclusion: Pre-operative PPI use following TSA was associated with increased early medical complications and higher rates of implant-related complications at midterm follow-up. These findings highlight the importance of careful medication review and risk stratification in patients undergoing anatomic TSA.
SN - 2471-5492
ER -