Association between preoperative proton pump inhibitor use and postoperative infectious and renal complications following major elective surgery
Bibliographic record
Abstract
Background: Use of poton pump inhibitors (PPIs) is associated with increased risk of Clostridioides difficile–associated colitis, pneumonia, and acute kidney injury. Their effect on postoperative complications is unknown. The objective of this study was to investigate the association between PPIs and the risk of C. difficile–associated colitis, pneumonia, and acute kidney injury following elective surgery. Methods: In this population-based, matched cohort study, we identified patients who had filled a PPI prescription within 90 days before major elective surgery (2010–2019). Study outcomes included C. difficile–associated colitis, pneumonia, acute kidney injury, gastrointestinal bleeding, and death within 90 days of surgery. We matched patients 1-to-1 on the basis of age, sex, procedure, date of surgery, and a propensity score predicting PPI exposure. We used logistic regression to evaluate between-group differences. Results: Of 313 163 patients, 89 047 (28.4%) used PPIs; of those, 79 681 were successfully matched to patients who did not use PPIs. The risk of the composite outcome (acute kidney injury, pneumonia, C. difficile–associated colitis, and death) among the patients who used PPIs was slightly higher than among the patients who did not use PPIs (10.6% v. 10.2 %), and was driven primarily by a higher rate of pneumonia among those who used PPIs (4.0% v. 3.7%). There was a lower rate of gastrointestinal bleeding among the patients who used PPIs (1.6% v. 1.8%). The risk of pneumonia was most pronounced in the subgroup undergoing hip and knee replacement (odds ratio 1.21, 95% confidence interval 1.08–1.36; p = 0.001). There were no significant differences between groups with regard to rates of C. difficile–associated colitis or acute kidney injury. Conclusion: We found that preoperative PPI use was associated with higher rates of pneumonia, particularly among patients undergoing hip and knee replacement surgery, and lower rates of gastrointestinal bleeding. Patients taking a PPI before surgery should be targeted for therapies aimed at reducing pneumonia risk, such as aggressive chest physiotherapy, following their operation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".