Stress Ulcer Prophylaxis in Orthopaedic Surgery

Although rare, stress-related gastrointestinal complications, such as perforated peptic ulcer (PPU) and upper gastrointestinal bleeding, can result in notable morbidity and mortality following orthopaedic surgery, particularly in elderly or critically ill patients. Despite widespread implementation of stress ulcer prophylaxis (SUP) in critical care, its role in orthopaedic surgical populations remains ill defined. A narrative review of the literature reveals a low incidence of PPU following orthopaedic procedures (0.054% after elective spine surgery); however, associated mortality may reach as high as 25% in cases of PPU. Identified risk factors include NSAID use, advanced age, notable comorbidities, and critical illness. SUP with proton pump inhibitors or histamine-2 receptor antagonists has been shown to reduce upper gastrointestinal bleeding in critically ill patients, leading to guideline-based recommendations for selective prophylaxis in high-risk individuals. Given the potential severity of these complications, orthopaedic surgeons should maintain vigilance and consider SUP in at-risk patients, while avoiding routine prophylaxis in low-risk cases. Tailoring prophylactic strategies to patient-specific risk factors aligns with best practices from critical care and may help mitigate preventable postoperative complications.