GLP-1 receptor agonists may raise complication, readmission risks after TSA
Key takeaways:
- Use of glucagon-like peptide-1 receptor agonists among patients undergoing shoulder arthroplasty was associated with poor outcomes.
- Patients using these had increased complication and readmission rates.
According to published results, patients using glucagon-like peptide-1 receptor agonists who undergo total shoulder arthroplasty may have increased risks for readmission and several postoperative complications vs. controls.
“Patients receiving GLP-1 receptor agonist therapy should be informed of potential perioperative risks, which may be influenced by their underlying comorbidities,” Jad J. Lawand, MS, a medical student from the John Sealy School of Medicine at the University of Texas Medical Branch, told Healio.
Lawand and colleagues performed a retrospective study of data from patients who underwent anatomic or reverse TSA between January 2010 and December 2023 with minimum follow-up of 90 days.
Lawand and colleagues analyzed data from 1,259 patients who used GLP-1s at the time of surgery and 1,259 patients who did not use GLP-1 receptor agonists at the time of surgery. Prior to propensity matching, patients who used GLP-1 receptor agonists were more likely to be overweight and have preoperative hypertension, heart failure, diabetes, liver disease, tobacco use and chronic kidney disease.
At 90-day postoperative follow-up, Lawand and colleagues found patients who used GLP-1 receptor agonists had significantly increased rates of deep vein thrombosis (1.6% vs. 0.9%; OR = 3), myocardial infarctions (1.6% vs. 0.9%; OR = 2.8), pneumonia (3.34% vs. 1.5%; OR = 2.25), blood transfusions (7.1% vs. 4.3%; OR = 1.7) and readmissions (8.1% vs. 5.2%; OR = 1.6) compared with patients who did not use GLP-1 receptor agonists. However, they found no significant differences between the groups in rates of stroke, pulmonary embolism, postoperative anemia or kidney failure at 90 days.
At 2-year follow-up, 776 patients in each cohort had complete outcomes. Lawand and colleagues found no significant differences in revision rates between patients who used GLP-1 receptor agonists vs. patients who did not use GLP-1 receptor agonists (3.2% vs. 1.8%; OR = 1.8).
“Further investigation into the perioperative risk assessment and medical optimization of patients utilizing GLP-1 receptor agonists may be warranted,” Lawand and colleagues wrote in the study.
Perspective
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The article “Glucagon-like peptide-1 receptor agonist use is associated with increased risk of perioperative complication and readmission following shoulder arthroplasty” by Jad J. Lawand, MS, and colleagues is an important warning for shoulder arthroplasty surgeons.
The glucagon-like peptide-1 revolution has taken hold and has already changed worldwide diabetes and obesity management. Shoulder surgeons are treating patients every day who are using these medications for the aforementioned diagnoses. With the eyes of research scientists fixed on this blockbuster class of drugs and the potential it may have to treat other conditions like Parkinsons, Alzheimer’s and chronic kidney disease, along with the prospect of less expensive oral versions of these drugs on the horizon, the likelihood that we will see more orthopedic patients on preoperative GLP-1 medication only continues to grow.
While the authors were able to demonstrate an increased risk of deep veinous thromboembolism, myocardial infarction, pneumonia, transfusion and readmission in the GLP-1 group, the cohort was unable to be subcategorized based on the use of GLP-1s for obesity or for diabetes which would have been helpful. In addition, these findings are in stark contrast to the hip and knee literature on the helpful impact GLP-1 receptor agonists have on hip and knee arthroplasty safety. Shoulder surgeons should consider counseling patients who use these medications about the potential for increased risk, but further research is required to confirm these findings.
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