GLP-1 receptor agonist use and surgical outcomes following diabetic foot reconstruction: A propensity score-matched retrospective cohort study.

Abstract

This study aimed to evaluate the association between glucagon-like peptide-1 receptor agonist (GLP-1 RA) use and surgical outcomes, complications, and healthcare utilization in diabetic patients undergoing soft-tissue reconstruction for foot ulcers. The TriNetX database was used to identify diabetic adult patients who underwent soft-tissue reconstruction for foot ulcers between January 2016 and February 2025. Cohorts were stratified by the history of GLP-1 RA use. A 1:1 propensity score matching was performed based on demographics, comorbidities, body mass index, and hemoglobin A1c. Risk ratios were compared for 90-day postoperative outcomes. After PSM, 1049 patients were included in each of the cohorts. GLP-1 RA users had lower 90-day rates of surgical-site infections (SSIs; 4.6% vs. 7.3%), revision surgery (3.7% vs. 6.3%), deep vein thrombosis (DVT; 2.1% vs. 5.0%), emergency department (ED) utilization (19.2% vs. 23.0%), and all-cause mortality (2.4% vs. 4.6%; all p<0.05) compared to nonusers. No significant differences were observed for wound dehiscence, pulmonary embolism, sepsis, and amputation rates (p>0.05). GLP-1 RA use in diabetic patients undergoing soft-tissue reconstruction for foot ulcers was associated with lower rates of SSIs, surgical revisions, DVT, ED utilization, and all-cause mortality compared to nonusers. These findings suggest a potential protective role of GLP-1 RA in surgical recovery independent of metabolic effects. Prospective and experimental investigation is needed to clarify the mechanism and full impact of GLP-1 RA on surgical outcomes.