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 glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications. Background: With the rapid growth of 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 health care system between February 2020 and 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. In 13,129 patients [48.0% men, 52.0% women; median (interquartile range) age, 67 (57, 75)], 35,020 procedures were propensity score matched. After matching, the active GLP-1 RA prescription group had a significantly reduced risk of 30-day readmission [relative risk (RR): 0.883; 95% CI: 0.789–0.987; P = 0.028; number needed to treat (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.