Utilization of Glucagon-Like Peptide-1 Receptor Agonist at the Time of Total Hip Arthroplasty for Patients Who Have Morbid Obesity.

Abstract

Background: Morbid obesity negatively affects outcomes after total hip arthroplasty (THA). The optimal strategy for weight loss before THA has not been identified. Recently, glucagon-like peptide-1 receptor agonists (GLP-1 RA) have become increasingly popular as an effective pharmacologic weight loss agent. The goal of this study was to evaluate the effect of perioperative GLP-1 RA use in patients who have morbid obesity undergoing primary THA on postoperative outcomes.

Methods: Using an administrative claims database, patients who had morbid obesity (body mass index [BMI] ≥ 40.0) undergoing primary THA were identified. Patients who had morbid obesity and GLP-1 RA use for three months before and after surgery (treatment) were matched to patients who had morbid obesity without GLP-1 RA use (control) and to a comparison group of patients who had severe obesity (BMI = 35.0 to 39.9) in a 1:4:4 ratio, resulting in 771, 3,084, and 3,084 patients in the treatment, control, and severe obesity comparison group, respectively. Overall group differences in 90-day and 2-year postoperative outcomes were compared using univariable tests, followed by post hoc pairwise testing and P-value adjustment.

Results: Patients who had morbid obesity on GLP-1 RA had a significantly lower rate of 90-day periprosthetic joint infection (PJI) (1.6 versus 3.2%; P = 0.03), readmission (6.9 versus 9.7%; P = 0.04), any medical complication (10.5 versus 14.1%; P = 0.03), and postoperative hematoma formation (0 versus 1.3%, P < 0.01) compared to controls. Patients who had morbid obesity on GLP-1 RA demonstrated lower rates of hematoma formation (0 versus 1.0%; P <0.01) compared to patients who had severe obesity (BMI = 35.0 to 39.9). There were no differences in 2-year surgical complications.

Conclusion: Perioperative use of GLP-1 RA in patients who had morbid obesity is associated with reduced risk of acute PJI and 90-day hospital readmission. The risk is reduced to a level comparable to obese patients who have a BMI < 40.0. Randomized controlled trials are necessary to determine the true effect and mechanism of action.