GLP-1RA exposure does not increase postoperative complication risk after operative ankle fracture fixation
Background
Ankle fractures are common, with high incidence in young adults, leading to significant healthcare burden. Patients with obesity and type 2 diabetes face increased fracture risk and reduced bone quality. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), like semaglutide and tirzepatide, are widely used for weight management and glycemic control. While some studies suggest GLP-1RAs may improve bone metabolism, their overall impact on fracture risk and postoperative outcomes remains uncertain, with conflicting evidence regarding potential adverse associations or no change. This uncertainty creates a critical gap for patients undergoing orthopedic surgery.
Study Design
This retrospective cohort study utilized the TriNetX research network to investigate the association between perioperative GLP-1RA exposure and postoperative complications. Researchers identified patients who underwent operative ankle fracture fixation and compared outcomes between those exposed to GLP-1RAs preoperatively and a control group. The study design aimed to analyze real-world data from a large patient population to assess the safety profile of GLP-1RAs in the context of orthopedic surgery, specifically looking at various postoperative adverse events and surgical risks, including aspiration and revision surgery.
Results
Preoperative exposure to GLP-1RAs was not broadly associated with an increased risk of postoperative complications following operative ankle fracture fixation. The study's conclusion indicated that GLP-1RA use did not lead to a higher incidence of adverse outcomes in the context of ankle fracture surgery. Functional outcomes, often measured by PROMIS scores, were rarely reported in the dataset, limiting insights into patient recovery and quality of life. The primary finding suggests a neutral or potentially beneficial safety profile for GLP-1RAs in perioperative settings. > In broader soft-tissue cohorts (rotator cuff repair and distal radius fixation) also examined, GLP-1RA exposure was associated with fewer adverse events without increasing the risk of aspiration or revision surgery.
Why It Matters
This study provides reassuring evidence for patients on GLP-1RAs undergoing orthopedic surgery, particularly for ankle fracture fixation. The finding that GLP-1RA exposure does not increase postoperative complication risk suggests that these medications generally do not need to be discontinued perioperatively due to concerns about surgical safety. Clinicians can be more confident in continuing GLP-1RA therapy in patients requiring operative ankle fracture fixation, potentially avoiding metabolic disruptions from pausing treatment. While functional outcomes were not extensively reported, the lack of increased adverse events is a significant practical takeaway for managing patients with metabolic conditions requiring surgery.