BACKGROUND: Patients with type II diabetes mellitus (T2DM) are known to have inferior postoperative outcomes after open reduction and internal fixation (ORIF) of ankle fractures. Semaglutide (the active agent in Ozempic) has encouragingly been associated with improved postoperative outcomes across multiple elective orthopaedic surgeries; however, this has not been assessed for patients with T2DM undergoing ankle fracture ORIF.
METHODS: Adult patients with T2DM who underwent ankle fracture ORIF were identified from the 2010-Q1 2023 PearlDiver M170Ortho database. Exclusion criteria included the following: age younger than 18, high-energy injury mechanisms, concomitant tibial plafond fracture, other non-ankle traumatic injuries, neoplastic or infectious diagnoses within 30 days preoperatively, and those with <90 days of follow-up. Patients with T2DM who used semaglutide within 1 year before ankle fracture ORIF were identified and matched 1:1 with patients with T2DM who had not used semaglutide based on age, sex, Elixhauser Comorbidity Index, end-organ diabetes complications, obesity (body mass index <30 vs. >30), insulin use, metformin use, sodium-glucose cotransport-2 inhibitor use, and insurance plan. The odds of 90-day adverse events were compared by multivariable logistic regression controlling for age, sex, and Elixhauser Comorbidity Index. Bonferroni correction of P < 0.005 was used to reduce the risk of type I error.
RESULTS: Among patients with T2DM undergoing ankle fracture ORIF, semaglutide use was noted for 2,700 patients (2.73%). After matching, there were 804 (+)semaglutide and 804 (-)semaglutide patients. On multivariable analysis, (+)semaglutide patients had significantly lower odds of 90-day deep vein thrombosis (odds ratio [OR] 0.24), myocardial infarction (OR 0.34), surgical site infection (OR 0.30), sepsis (OR 0.38), pneumonia (OR 0.27), urinary tract infection (OR 0.27), wound dehiscence (OR 0.31), and emergency department visit (OR 0.45; P < 0.001 for all).
CONCLUSION: This study found reductions in 90-day cardiovascular and infectious complications after ORIF of ankle fractures for patients with T2DM using semaglutide preoperatively as part of their glycemic control regimen.
LEVEL OF EVIDENCE: Level III.
