Evaluating the safety of glucagon-like peptide-1 agonist use in non-diabetic overweight patients undergoing shoulder arthroplasty.

BACKGROUND

Initially indicated for diabetes mellitus (DM), glucagon-like peptide 1 (GLP-1) agonists are now indicated for obesity management in isolation of DM. While prior studies have examined post-operative outcomes after total shoulder arthroplasty (TSA) in GLP-1 users with DM, there is a paucity of literature evaluating its use in non-diabetic patients for weight loss rather than glucose control. Therefore, our analysis compared 90-day and 2-year outcomes following TSA between non-diabetic obese GLP-1 users and a matched cohort of obese GLP-1 non-users.

METHODS

The PearlDiver Mariner database was queried to identify patients who underwent anatomic TSA and reverse TSA between 2010 and 2023. Patients with a history of DM or who underwent TSA for cancer, infection, or pathologic fractures were excluded. Patients with a body mass index ≥ 30 kg/m2 within 6 months of surgery were included. GLP-1 users (within 3 months of surgery) were matched in a 1:10 ratio to GLP-1 non-users by age, sex, Elixhauser Comorbidity Index, smoking status, and various comorbidities. Multivariate logistic regression models were utilized to compare outcomes at 90 days and 2 years.

RESULTS

After matching, 462 GLP-1 users and 4,377 GLP-1 non-users were included in our analysis. GLP-1 users had higher readmission rates (odds ratio: 2.034; 95% confidence interval: 1.594-2.578; P < .001) and subsequently overall complication rates (odds ratio: 1.474; 95% confidence interval: 1.295-1.799; P < .001) compared to GLP-1 non-users at 90 days. However, no differences were seen between cohorts for the remaining 90-day outcomes nor for all evaluated 2-year outcomes including prosthetic joint infection, fracture, and all-cause revision.

DISCUSSION: Our analysis found a higher incidence of overall complications at 90 days among obese, non-diabetic GLP-1 users, driven largely by an increased incidence of readmissions. However, there were largely comparable outcomes at 2 years. These findings suggest that while GLP-1 agonists may be reasonable to use in the perioperative period, interventions to reduce readmissions among these patients may be warranted.