The impact of glucagon-like peptide-1 (GLP-1) receptor agonists on postoperative outcomes following rotator cuff repair.

Abstract

Patients with type II diabetes mellitus (T2DM) undergoing rotator cuff repair (RCR) have increased postoperative risk. Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly used in T2DM, but their perioperative safety remains uncertain. This study evaluated the association between preoperative GLP-1 agonist exposure and postoperative outcomes following RCR. A retrospective cohort study using the TriNetX Research Network identified adults with T2DM undergoing RCR between 2018 and 2024. Patients were stratified by preoperative GLP-1 agonist exposure. Outcomes included 90-day medical complications, surgical complications, and healthcare utilization. Univariate and inverse propensity score-weighted binary logistic regression were performed to adjust for confounding. Among 5876 patients, 233 used GLP-1 preoperatively. Unadjusted analyses revealed increased odds of postoperative respiratory complications (odds ratio (OR): 1.97, 95% confidence interval (CI): 1.32-2.86, <i>P</i> = 0.0006), urinary tract infection (OR: 3.85, 95% CI: 1.31-9.12, <i>P</i> = 0.0055), and postoperative stiffness (OR: 2.20, 95% Cl: 1.31-3.49, <i>P</i> = 0.0016) among GLP-1 users. After inverse propensity score-weighting, no significant differences in postoperative outcomes were observed. Preoperative GLP-1 agonist use was not independently associated with decreased or increased risk of postoperative complications following RCR. These findings suggest perioperative continuation of GLP-1 therapy may be safe, though prospective studies are warranted.