The impact of GLP-1 receptor agonists on postoperative outcomes following total shoulder arthroplasty

Abstract

Background

Total Shoulder Arthroplasty (TSA) is a commonly performed orthopedic procedure for shoulder arthritis. Type II Diabetes Mellitus (T2DM) has been associated with negative postoperative outcomes following TSA. Glucagon-like peptide-1 receptor (GLP-1) agonists are increasingly popular drugs that have proven to be effective in the management of T2DM. To date, there is no study evaluating the complication profile following TSA of patients taking GLP-1 agonists.

Methods

A retrospective cohort analysis was conducted on patients from the TriNetX Database who underwent TSA between January 2018 and December 2023. All patients had a diagnosis of T2DM at the time of index procedure. Patients were stratified into two groups according to their GLP-1 agonist prescription status. Medical complications that occurred within 90 days and surgical complications that occurred within 2 years of index procedure were collected. A univariate logistic regression analysis was conducted to examine the initial connection between the active use of GLP-1 agonists and postoperative outcomes. Subsequently, an inverse propensity score-weighted binary logistic regression was used to adjust for potential biases.

Results

A total of 8254 patients met our inclusion criteria. The “non-GLP-1” and “GLP-1” groups included 7749 and 505 patients, respectively. The use of GLP-1 agonists did not incur increased risk of any medical or surgical complications following TSA. Our unadjusted analysis demonstrated that the use of GLP-1 agonists was significantly associated with lower odds of mortality within 90 days of surgery (OR 0.17, 95% CI 0.0043-0.99, P = .0435). GLP-1 agonist use was associated with decreased risk of mortality within 90 days when subjected to inverse propensity score-weighted analysis (OR 0.077, 95% CI 0.011-0.554, P = .011). The use of GLP-1 agonists was not a predictor for any other medical or surgical complications in inverse-propensity score weighted-analysis, although decreased risk of wound dehiscence approached significance (OR 0.256, 95% CI 0.061-1.074, P = .063).

Conclusion

Preoperative GLP-1 agonist use is associated with reduced 90-day mortality in T2DM patients undergoing TSA, without increasing other postoperative complications. These findings support the continued use of GLP-1 agonists in perioperative management to optimize surgical outcomes in this patient population.