Proton Pump Inhibitor Use Affects Pseudarthrosis Rates and Influences Patient-Reported Outcomes

Mangan, John J.; Divi, Srikanth N.; McKenzie, James C.; Stull, Justin D.; Conaway, William; Casper, David S.; Goyal, Dhruv K.C.; Nicholson, Kristen; Galetta, Matthew S.; Wagner, Scott C.; Kaye, I. David; Kurd, Mark F.; Woods, Barrett I.; Radcliff, Kris; Rihn, Jeffery A.; Anderson, D. Greg; Hilibrand, Alan S.; Vaccaro, Alexander R.; Schroeder, Gregory D.; Kepler, Christopher K.

doi:10.1177/2192568219853222

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Interestingly, non-unions never reached consensus as a post-operative complication. This outcome is particularly challenging to assess, as it has been frequently identified during long-term follow-up, and has been associated with numerous non-surgical patient factors, such as medication use, smoking, and systemic comorbidities [ 47 , 48 ]. As such, it is difficult to ascertain the role that operative factors may play in contributing to pseudarthrosis.…”

Section: Discussionmentioning

confidence: 99%

Establishing a Standardized Clinical Consensus for Reporting Complications Following Lateral Lumbar Interbody Fusion

Ito¹,

Lakomkin

Shahidi

et al. 2023

Medicina

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Background and Objectives: Mitigating post-operative complications is a key metric of success following interbody fusion. LLIF is associated with a unique complication profile when compared to other approaches, and while numerous studies have attempted to report the incidence of post-operative complications, there is currently no consensus regarding their definitions or reporting structure. The aim of this study was to standardize the classification of complications specific to lateral lumbar interbody fusion (LLIF). Materials and Methods: A search algorithm was employed to identify all the articles that described complications following LLIF. A modified Delphi technique was then used to perform three rounds of consensus among twenty-six anonymized experts across seven countries. Published complications were classified as major, minor, or non-complications using a 60% agreement threshold for consensus. Results: A total of 23 articles were extracted, describing 52 individual complications associated with LLIF. In Round 1, forty-one of the fifty-two events were identified as a complication, while seven were considered to be approach-related occurrences. In Round 2, 36 of the 41 events with complication consensus were classified as major or minor. In Round 3, forty-nine of the fifty-two events were ultimately classified into major or minor complications with consensus, while three events remained without agreement. Vascular injuries, long-term neurologic deficits, and return to the operating room for various etiologies were identified as important consensus complications following LLIF. Non-union did not reach significance and was not classified as a complication. Conclusions: These data provide the first, systematic classification scheme of complications following LLIF. These findings may improve the consistency in the future reporting and analysis of surgical outcomes following LLIF.

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Section: Discussionmentioning

confidence: 99%

Establishing a Standardized Clinical Consensus for Reporting Complications Following Lateral Lumbar Interbody Fusion

Ito¹,

Lakomkin

Shahidi

et al. 2023

Medicina

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“…Although we acknowledge that this result needs to be confirmed on a larger sample, previous studies showed that patients taking PPIs have an increased the risk of non-union in tibial and femoral shaft fractures compared with non-users [ 32 ]. Another recent report has shown that patients on PPIs may have higher non-union rates following an anterior cervical discectomy and fusion [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

The correlates of post-surgical haematoma in older adults with proximal femoral fractures

Ruggiero

Pioli²,

Petruccelli³

et al. 2023

Aging Clin Exp Res

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Background Little is known about the incidence of haematoma, and clinical correlates among orthogeriatric patients. Aims This study aims to describe the incidence of haematoma after surgical repair of hip fracture and to identify the clinical correlates of haematoma among orthogeriatric patients. Methods Two orthopaedic surgeons and a dedicated operator using ultrasound technique, each other in blindness, evaluated 154 orthogeriatric patients during their hospital stay. All patients received a comprehensive geriatric assessment. We investigated the concordance between clinical diagnosis and ultrasound detection of haematoma, and then we explored the clinical correlates of the onset of post-surgical haematoma. Results Blood effusion at the surgical site was detected in 77 (50%) patients using ultrasound technique; orthopaedic surgeons reached a clinical agreement about post-surgical haematoma in 18 (23%) patients. The sensitivity of clinical evaluation was 0.66, and the specificity was 0.70. Independent of age, clinical, pharmacological, and surgical confounders, proton pump inhibitors (PPIs) were associated with post-surgical haematoma (OR 2.28; 95% CI 1.15–4.49). A tendency towards association was observed between selective serotonin reuptake inhibitors and post-surgical haematoma (OR 2.10; 95% CI 0.97–4.54), Conclusions Half of older patients undergoing surgical repair of proximal femoral fracture develop a post-surgical haematoma. Clinical assessment, even if made by senior orthopaedic surgeons, underestimates the actual occurrence of post-surgical haematoma compared to ultrasound detection. Ultrasound technique may help to detect haematoma larger than 15 mm better than clinical assessment. PPIs’s use is a risk factor for post-surgical haematoma independent of several medical and surgical confounders.

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“…The potential link between nonunion and JK/JF should lead the surgeon to ensure that fusion is indeed established, either by optimizing the surgical strategy or by eliminating risk factors such as postoperative nonsteroidal anti-inflammatory drugs,[ 22 ] steroids,[ 23 ] or proton-pump inhibitors. [ 24 ]…”

Section: Discussionmentioning

confidence: 99%

Junctional kyphosis and junctional failure after multi-segmental posterior cervicothoracic fusion – A retrospective analysis of 64 patients

Spiessberger

Dietz

Grüter

et al. 2020

J Craniovert Jun Spine

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Introduction: Junctional kyphosis (JK) and junctional failure (JF) are known complications after thoracolumbar spinal deformity surgery. This study aims to define the incidence and possible risk factors for JK/JF following multi-segmental cervicothoracic fusion. Methods: This is a retrospective analysis of 64 consecutive patients undergoing cervicothoracic fusion surgery, including at least five segments. Clinical and radiographic outcome measures were analyzed. A univariate analysis was performed to determine the effect of the level of upper instrumented vertebra (UIV) and lower instrumented vertebra (LIV), fusion status, C2 sagittal vertical axis (SVA), C2–C7 lordotic angle and T1 slope angle on the occurrence of JK/JF. Results: A total of 46 patients were followed up for a median of 1.1 years (range 0.3–4) with a median age of 65.5 years (range 42.2–84.5). Indication for surgery was spinal stenosis in 87%, trauma in 7%, and tumor in 6% of cases. The median number of levels fused was 7; the most frequent UIV was C2, and the most frequent LIV was T2. Solid fusion was achieved in 78% at the last follow-up. Postoperatively, the median C2 SVA was 32 mm (range − 7–75), median T1 slope angle was 33° (range 2°–57°), C2–C7 sagittal cobb angle was 4° (−29°–12°). JK developed in 4% of cases, no case of JF was observed. No statistically significant impact of bone density, level of UIV, level of LIV or postoperative sagittal parameters on the occurrence of JK/JF was observed, even though fusion status and pathologic T1 slope angle showed a trend toward significance. Conclusion: In this cohort of patients with mildly pathologic sagittal balance, JK was a rare event after multi-segmental fusion, observed in only 4% of cases. Neither level of UIV nor LIV had an influence on its occurrence; however, nonunion and pathologic sagittal alignment showed a nonsignificant trend.

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Proton Pump Inhibitor Use Affects Pseudarthrosis Rates and Influences Patient-Reported Outcomes

Cited by 5 publications

References 21 publications

Establishing a Standardized Clinical Consensus for Reporting Complications Following Lateral Lumbar Interbody Fusion

Establishing a Standardized Clinical Consensus for Reporting Complications Following Lateral Lumbar Interbody Fusion

The correlates of post-surgical haematoma in older adults with proximal femoral fractures

Junctional kyphosis and junctional failure after multi-segmental posterior cervicothoracic fusion – A retrospective analysis of 64 patients

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