Association between pre-operative sodium-glucose cotransporter-2 inhibitor use and postoperative outcomes: a propensity score-matched analysis of the TriNetX database.

Abstract

While sodium-glucose cotransporter-2 inhibitors offer cardiovascular and renal benefits, their peri-operative safety and effect profile remain unclear. This study aimed to evaluate the association between pre-operative sodium-glucose cotransporter-2 inhibitor use and postoperative adverse events in patients with type 2 diabetes mellitus. This nationwide propensity-score matched cohort study utilised the TriNetX database to analyse data from patients with type 2 diabetes mellitus who underwent surgery in the USA. Patients were categorised based on whether they had received a prescription for sodium-glucose cotransporter-2 inhibitors 90 days before surgery. The primary outcome was 30-day all-cause mortality. Secondary outcomes included the incidence of major adverse cardiovascular events; acute kidney injury; and diabetic ketoacidosis. In 98,118 matched pairs, 30-day all-cause mortality was significantly lower in patients in the sodium-glucose cotransporter-2 inhibitor group compared with those in the control group (RR 0.61, 95%CI 0.55-0.67, p < 0.001). Patients receiving sodium-glucose cotransporter-2 inhibitor treatment also showed lower risks of major adverse cardiovascular events (RR 0.89, 95%CI 0.86-0.91); acute kidney injury (RR 0.71, 95%CI 0.69-0.74); and diabetic ketoacidosis (RR 0.31, 95%CI 0.18-0.540) (p < 0.001 for all comparisons). Subgroup analyses revealed a more pronounced reduction in mortality among females, patients living with obesity or proteinuria, and those undergoing cardiovascular surgery. Our study showed a significantly reduced risk of postoperative mortality and morbidity associated with pre-operative sodium-glucose cotransporter-2 inhibitor use in patients with type 2 diabetes mellitus, including a notably lower rate of diabetic ketoacidosis, contrary to previous concerns. Randomised controlled trials are warranted to validate these findings.