Glucagon-like Peptide-1 Receptor Agonists Reduce Surgical Complications in Diabetic Patients

PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are becoming common pharmacotherapies for treating diabetes and weight management. Prescription rates have increased over 200% between 2016 and 2021 (1). These medications have multi-system impacts and no previous studies have examined their safety in surgical patients. This study examined the effect of GLP-1 receptor agonists on the rate of post-operative complications and rates of readmission in diabetic patients undergoing surgery. METHODS: We identified all patients undergoing open and closed surgical procedures at a quaternary care hospital in New York City from February 1st, 2020 to July 1st, 2023. Eye and ear surgeries were excluded. Patients with Type 1 and Type 2 diabetes were divided into two groups: patients receiving GLP-1 RA drugs at the time of surgery as part of their diabetes management and patients receiving standard of care diabetes management without GLP-1 RA drugs. Primary outcomes were postoperative complications within six months of the surgery date and hospital readmissions within 30 days of discharge. Subgroup analyses were performed in open and closed procedures and common plastic surgery procedures. RESULTS: A total of 41,932 surgical procedures in 16,023 patients were included, with 9,118 (21.7%) procedures in patients with an active prescription for GLP-1 RA medications at or before the time of surgery. Patients on GLP-1 RAs were younger (65 vs. 68, p<0.001), had a higher BMI (29.23 kg/m2 vs. 28.19 kg/m2, p < 0.001), and had higher rates of T2DM (96.6% vs. 91.7%, p<0.001) compared to patients not taking GLP-1 RA medications. This group also had higher preoperative hemoglobin A1C and rates of comorbid arteriosclerosis, heart failure, cirrhosis, obesity, and hypercholesteremia/hyperlipidemia (p < 0.05). Postoperatively, the GLP-1 RA group had lower rates of hematoma (0.1% vs. 0.3%, p=0.002) and readmission within 30 days (5.4% vs. 7.6%, p<0.001). In sub-analyses, the readmission rate in the GLP-1 RA group was lower than the non-GLP-1 RA group in both open (6.6% vs. 8.3%, p<0.001) and closed (4.5% vs. 6.3%, p<0.001) procedures. Hematoma rates were decreased in the GLP-1 RA group only in open surgeries (0.2% vs. 0.4%, p=0.005). In plastic surgery procedures, active GLP-1 RA use was not associated with significant differences in complication or readmission rates (p>0.05), although this may reflect an insufficient number of patients/surgeries in this sub-analysis. CONCLUSION: In this first study examining the effects of GLP-1 RA medications in surgical patients, we found these medications decreased postoperative hematoma and 30-day readmission rates, despite being taken by patients with higher Hgb A1C levels and rates of comorbidities. Further study is ongoing to elucidate the mechanism of the observed protective effect and to identify sub-groups of patients and procedures where taking GLP-1 RA medications is particularly beneficial. Plastic and reconstructive surgeons may be assured that active GLP-1 RA use is safe in diabetic patients undergoing surgery. REFERENCES: 1. Dzaye O, Berning P, Razavi AC, et al. Online searches for SGLT-2 inhibitors and GLP-1 receptor agonists correlate with prescription rates in the United States: An infodemiological study. Front Cardiovasc Med. 2022;9:936651. doi:10.3389/fcvm.2022.936651