Association of Perioperative Glucagon-like Peptide-1 Receptor Agonist Use and Postoperative Outcomes

Objective: To assess rates of surgical complications and postoperative readmission in diabetic patients with and without active perioperative prescriptions for GLP-1 RA medications. Background: With the rapid growth of glucagon-like peptide-1 receptor agonist (GLP-1 RA) use in the United States, it is important to understand the potential effect of these drugs on surgical outcomes broadly. Methods: In this retrospective, observational cohort analysis, patients with a diagnosis of type 1 or type 2 diabetes undergoing a surgical procedure at a multicenter quaternary-care healthcare system between February 2020 to July 2023 were included. Propensity score matching was performed between procedures in patients with and without an active GLP-1 RA prescription. The primary outcome was 30-day readmission, and secondary outcomes were documented dehiscence, infection, hematoma, and bleeding within 180 days after surgery. Results: Among 74,425 surgical procedures in 21,772 patients included in the analysis, 27.2% were performed in the setting of an active GLP-1 RA prescription. 35,020 procedures in 13,129 patients (48.0% men, 52.0% women; median [IQR] age, 67 [57, 75]) were propensity score matched. After matching, the active GLP-1 RA prescription group had a significantly reduced risk of 30-day readmission (RR, 0.883; 95% CI, 0.789-0.987; P =0.028; NNT, 219; 95% CI, 191-257), postoperative wound dehiscence (RR, 0.711; 95% CI, 0.577-0.877; P =0.001; NNT, 266; 95% CI, 202-391), and postoperative hematoma (RR, 0.440; 95% CI, 0.216-0.894; P =0.023; NNT, 1786; 95% CI, 652-2416). No significant differences were seen in rates of infection and bleeding. Conclusions: An active perioperative GLP-1 RA prescription in patients with diabetes was associated with significant reductions in risk-adjusted readmission, wound dehiscence, and hematoma, and no difference in infection and bleeding rates. Further study is warranted to elucidate any causal association.