Impact of glucagon-like peptide-1 receptor agonists on postoperative outcomes following ankle fracture open reduction and internal fixation

📖 Top 30% JournalMay 9, 2025The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

How glucagon-like peptide-1 receptor agonists affect recovery after ankle fracture surgery

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Abstract

Among 123,546 patients not taking GLP-1RA and 1,173 patients taking GLP-1RA, the no GLP-1RA cohort had a 95% confidence interval indicating a significantly higher rate of hardware removal at 30 days post-surgery.

GLP-1 receptor agonists are increasingly used for diabetes and weight management but have been underexplored in ankle fracture recovery.
A comparison of two matched cohorts (1,173 patients each) revealed no significant differences in demographics or comorbidities.
Both cohorts had high prevalence rates, with 75.6% of patients having diabetes mellitus and 68.7% being overweight or obese.
At 30 days post-surgery, the group not receiving GLP-1RA showed a significantly higher likelihood of hardware removal.
No significant differences were observed in complications at 30 days, 90 days, 1 year, or 5 years among the two groups.

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Glucagon-like peptide-1 receptor agonists (GLP-1RA) are quickly growing in popularity as effective tools in the management of diabetes and weight loss. Despite this increased usage, there is a paucity of literature investigating the use of GLP-1RA in patients with ankle fractures. This study aims to compare the outcomes of patients undergoing ankle fracture open reduction and internal fixation (ORIF) receiving therapy with GLP-1RA to those not receiving treatment. A retrospective analysis was performed utilizing the TriNetX research network to query patients who underwent ankle fracture ORIF between 2000-2024. Two cohorts were established according to preoperative GLP-1RA usage with 1:1 matching by propensity scores for demographics and comorbidities. Primary outcomes included the risk of postoperative complications (i.e. infection, sepsis, wound dehiscence, cellulitis, thrombosis, nonunion, reoperation, revision, etc.) at 30-days, 90-days, 1-year, and 5-years. There were 123,546 patients not taking GLP-1RA and 1,173 patients taking GLP-1RA who underwent ORIF for an ankle fracture, with propensity score matching resulting in two cohorts of 1,173 patients each. After matching, there were no significant differences in demographics or comorbidities, including a 75.6 % prevalence of diabetes mellitus and 68.7 % prevalence of overweight or obesity in both cohorts. At 30-days postoperatively, the no GLP-1RA cohort had a significantly higher rate of removal of hardware (Odds Ratio [OR] 1.953, 95 % Confidence Interval (CI) 1.062-3.591); no other complications demonstrated significant differences at 30-days, 90-days, 1-year, or 5-years postoperatively. These findings further underscore the low risk of preoperative GLP-1RA usage noted in other orthopaedic procedures.

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