Glucagon-like peptide-1 receptor agonist use is associated with increased risk of perioperative complication and readmission following shoulder arthroplasty

🎖️ Top 10% JournalNov 11, 2024Journal of shoulder and elbow surgery

Use of GLP-1 drugs linked to higher risk of complications and hospital return after shoulder replacement surgery

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Abstract

GLP-1 receptor agonist users experienced higher rates of postoperative complications, including deep vein thrombosis and myocardial infarction.

In the 90-day postoperative period, users of GLP-1 receptor agonists had a 1.6% rate of deep vein thrombosis compared to 0.9% in non-users.
The incidence of myocardial infarction was 1.6% in GLP-1 receptor agonist users versus 0.9% in controls.
Pneumonia occurred in 3.34% of GLP-1 receptor agonist users, while only 1.50% of non-users experienced this complication.
The need for blood transfusion was noted in 7.1% of patients using GLP-1 receptor agonists, compared to 4.3% in the control group.
Readmission rates were 8.1% for GLP-1 receptor agonist users, compared to 5.2% for non-users.
No significant differences were found in stroke, pulmonary embolism, postoperative anemia, or renal failure rates.

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BACKGROUND: Glucagon-like peptide-1 (GLP-1) receptor agonists, increasingly used for diabetes management and weight loss, have been linked to lower readmission rates after knee and hip arthroplasty. However, their impact on total shoulder arthroplasty (TSA) outcomes remains unclear. This study investigates the effects of GLP-1 receptor agonists on major complications and revisions following TSA.

METHODS: A retrospective query of the TriNetX database from 2010 to 2023 was performed to identify patients who underwent anatomic or reverse TSA and were prescribed GLP-1 receptor agonists. GLP-1 receptor agonist users were 1:1 propensity score-matched to controls for demographic factors and comorbidities, yielding 1259 patients in each group. Outcomes included 90-day postoperative medical complications and readmission and revision surgery at 2 years. Odds ratios (ORs), 95% confidence intervals, and P values were calculated. After Bonferroni correction, P < .005 was considered significant.

RESULTS: GLP-1 receptor agonist users (n = 1259) experienced significantly higher rates of deep vein thrombosis (1.6% vs. 0.9%; OR 3.0; P = .001), myocardial infarction (1.60% vs. 0.9%; OR 2.84; P = .003), pneumonia (3.34% vs. 1.50%; OR 2.25; P = .003), transfusion (7.1% vs. 4.3%; OR 1.7; P = .003), and readmission (8.1% vs. 5.2%; OR 1.6; P = .004) in the 90-day postoperative period compared to patients not taking GLP-1 receptor agonists. There were no differences in the rates of stroke, pulmonary embolism, postoperative anemia, or renal failure. In patients with a minimum 2-year follow-up (n = 776), there was no difference in revision rate (3.2% vs. 1.8%; OR 1.8; P = .07).

CONCLUSION: GLP-1 receptor agonist use during TSA was associated with an increased risk of deep vein thrombosis, myocardial infarction, pneumonia, need for transfusion, and readmission. Further investigation into the perioperative risk assessment and medical optimization of patients utilizing GLP-1 receptor agonists may be warranted.

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