GLP-1 Agonists' Effect on Infection and Union after Tibiotalar Fusion, Subtalar Fusion, Triple Arthrodesis.

Abstract

GLP-1 agonist use has increased due to the rising prevalence of obesity and diabetes mellitus. Foot and ankle surgeons provide orthopaedic care to diabetic patients. The effects of GLP-1 agonists on foot fusion outcomes are not well explored. The TriNetX Global Collaborative Network was queried using <i>CPT</i> codes for patients with diabetes mellitus undergoing open tibiotalar fusions, subtalar fusions, and triple arthrodesis. Outcomes were assessed at 1 year after index surgical procedure. Cohort balancing was performed according to age at procedure, race, sex, and nicotine dependence, for body mass index, glycated hemoglobin (HbA_1c), and estimated glomerular filtration rate (eGFR). Statistical significance was set at <i>P</i> <.05 with associated 95% CIs. Two cohorts of 783 patients undergoing tibiotalar, subtalar, or triple arthrodesis fusions were compared using <i>CPT</i> coding in this study (Table 1). Among patients treated with GLP-1 agonists, the overall rate of postoperative pseudarthrosis was found to be lower (15.9% vs 20.2%, <i>P</i> = .0129, RR 1.26 (1.02-1.56). Comparison of constituent procedures in isolation showed a lower rate of pseudarthrosis for patients using GLP-1 agonist than matched controls: subtalar fusion (17.2% vs 23.4%, <i>P</i> = .0292, RR 1.36, 95% CI 1.03-1.79) and triple arthrodesis (12.4% vs 21.9%, <i>P</i> = .0120, RR 1.76, 95% CI 1.12-2.76). No significant difference was found in rates of pseudarthrosis after tibiotalar fusion (19.8% vs 21.5%, <i>P</i> = .5692, RR 1.09, 95% CI 0.81-1.46). No difference was detected in postoperative infection rates for any of the procedure types (Table 3). Results suggest a previously unreported better fusion rates associated with GLP-1 agonist use after fusion procedures of the foot and ankle. This study also shows no clear risk or benefit associated with GLP-1 agonists with respect to postoperative infection. Additional clinical studies are needed to clarify this association.