Perioperative Proton Pump Inhibitors Versus H2-Receptor Antagonists and 1-Year Complications After Distal Radius ORIF: A Propensity-Matched Cohort Study

Purpose: Proton pump inhibitors (PPIs) are frequently used for gastroprotection and have recently been linked to postoperative infection and impaired bone healing. Whether PPIs versus histamine-2 receptor antagonists (H2RAs) differentially affect wrist fixation outcomes is uncertain. We compared perioperative PPI and H2RA exposure and 1-year complications after distal radius open reduction and internal fixation (ORIF). Methods: A retrospective, propensity score-matched cohort study was conducted using the TriNetX Network. Adults who underwent surgery within 14 days of distal radius fracture diagnosis were included with the ORIF date serving as the index. Exposure was defined as mutually exclusive PPI versus H2RA from day -90 to +30 relative to the index. Outcomes were assessed from postoperative days 1 to 365 and included device-related infection, deep hardware removal, postoperative infection, and nonunion repair. We estimated 1-year absolute risks, risk ratios (RRs), and Cox hazard ratios (HRs). Results: After matching, the PPI versus H2RA analysis included 5858 patients per arm with up to 1-year follow-up. Device-related infection occurred in 61 PPI users (1.0%) versus 30 H2RA users (0.5%) (RR, 2.03; HR, 2.00; 95% CI, 1.29-3.09). Deep hardware removal occurred in 766 PPI users (13.1%) versus 500 H2RA users (8.5%) (RR, 1.53; HR, 1.54; 95% CI, 1.37-1.72). Postoperative infection occurred in 103 PPI users (1.8%) versus 64 H2RA users (1.1%) (RR, 1.61; HR, 1.58; 95% CI, 1.16-2.16). Nonunion repair occurred in 64 PPI users (1.1%) versus 38 H2RA users (0.6%) (RR, 1.68; HR, 1.65; 95% CI, 1.10-2.46). Conclusions: Perioperative PPI exposure was associated with higher 1-year risks of device infection, postoperative infection, deep hardware removal, and surgically treated nonunion after distal radius ORIF. These findings should be interpreted cautiously and do not definitively determine whether temporary discontinuation of chronic PPIs alters risks after distal radius ORIF. However, these findings highlight the need for further investigation of this association in future well-designed institution-based or prospective studies. Type of study/level of evidence: Prognostic III.