The Impact of Proton Pump Inhibitor Use on Postoperative Complications in Anterior and Posterior Cervical Fusion Surgery: A Comparative Cohort Study

Background: Cervical spine fusion surgeries, including anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF), are indicated to address cervical spine diseases. Proton pump inhibitors (PPIs), widely used for acid-related disorders, may influence bone metabolism and potentially affect surgical outcomes. This study investigates the association between preoperative PPI use and complications after cervical spine fusion. Methods: Using the TriNetX database, we performed a retrospective analysis comparing outcomes in patients undergoing cervical spine fusion with or without PPI use. Cohorts were identified based on PPI use within 90 days before surgery and matched using propensity scores to balance demographic and other potentially confounding clinical factors. Outcomes were evaluated over a 90-day postoperative period for ACDF, PCDF, and combined procedures. Results: Within 90 days postoperatively, preoperative PPI use was associated with significantly increased risks of several complications. In ACDF only, PPI use increased the risk of myocardial infarction (MI) (RR: 1.464, P =0.036), acute kidney injury (AKI) (RR: 1.367, P =0.006), sepsis (RR: 1.341, P =0.02), wound disruption (RR: 1.525, P =0.01), and infection (RR: 1.319, P =0.008). In PCDF only, PPI use increased the risk of sepsis (RR: 1.305, P =0.004). Combined cervical fusion procedures led to higher risks of stroke (RR: 1.233, P =0.033), MI (RR: 1.303, P =0.018), sepsis (RR: 1.238, P =0.001), AKI (RR: 1.326, P <0.001), infection (RR: 1.220, P <0.001), and wound disruption (RR: 1.260, P <0.001) in patients with PPI use compared with non-users. Conclusions: These findings suggest that PPI use may be associated with increased risk of complications after cervical spine fusion. Further research is needed to understand the mechanisms of this association and guide management strategies for PPI use in these patients.