166. Active GLP-1 RA Use Correlates With Lower Rates of Surgical Complications Across Diabetic BMI Cohorts: A Retrospective Analysis of 72,578 Surgical Encounters

PURPOSE: Glucagon-like peptide-1 receptor agonist (GLP-1 RA) use in the United States has observed rapid growth in recent years. Initially approved for Type 2 diabetes mellitus (T2DM), more recently the FDA approved indication expansion for weight management in overweight and obese adults. In light of the growing population of surgical candidates that are actively prescribed GLP-1 RA therapies, an understanding of their potential effects on postoperative surgical outcomes is paramount, particularly in patients with comorbid diabetes and/or obesity who are inherently at risk for a poorer postoperative course. GLP-1 RA use has previously demonstrated a protective effect in metabolic, cardiac, and renal function: the translation of these benefits to the perioperative period, despite potential anesthetic concern of pulmonary aspiration from delayed gastric emptying, remains underreported. We therefore sought to analyze rates of surgical complications and postoperative readmission in diabetic patients who were stratified by BMI as normal weight, overweight, obese, or morbidly obese. METHODS: A retrospective, observational cohort analysis was conducted in all patients diagnosed with type 1 or type 2 diabetes mellitus undergoing a surgical procedure between February 2020 to July 2023 at a multicenter quaternary-care healthcare system. Patients with and without an active GLP-1 RA prescription were compared in each of four cohorts: normal weight (BMI 18.5 - 24.9 kg/m2), overweight (BMI 25 - 29.9 kg/m2), obese (BMI 30 - 40 kg/m2), and morbidly obese (BMI > 40 kg/m2). Outcomes examined were documented dehiscence, infection, hematoma, and bleeding within 180 days after surgery, and readmission within 30-days. RESULTS: From a sample of 72,578 surgical procedures in 21,544 patients with diabetes, 8% of patients were classified as morbidly obese, 35% as obese, 34% as overweight, and 23% as normal weight. Within these four weight categories, the rate of active GLP-1 RA prescription was 46.5%, 33.8%, 24.4%, and 15.4%, respectively. Mean A1C of GLP-1 RA prescribed patients was 7.16%, 7.28%, 7.30%, 7.53%, significantly higher than non-prescribed (6.71%, 6.76%, 6.79%, 6.71%, respectively). Patients actively prescribed GLP-1 RA medications demonstrated significantly reduced relative risk of post-operative wound dehiscence in morbidly obese (0.40), obese (0.67), overweight (0.60), and normal weight (0.59) cohorts. Further, active GLP-1 RA prescription was correlated with significantly reduced readmission risk in all cohorts (0.55, 0.62, 0.82, 0.74, respectively). A reduced risk of postoperative hematoma was observed in GLP-1 RA patients classified as obese (0.19). No significant differences were observed in rates of postoperative infection or bleeding. CONCLUSION: Active perioperative GLP-1 RA prescription was associated with significant reductions in readmission and wound dehiscence in diabetic patients across weight categories, despite higher A1C levels. Moreover, the relative risk of these outcomes with active GLP-1 RA use was lowest in morbidly obese patients. These findings suggest a potential wound healing benefit, particularly noteworthy for higher BMI cohorts. Interestingly, several animal studies have demonstrated evidence of GLP-1 RA inflammation attenuation and improved tissue wound healing. These results hold promising implications for diabetic and obese/overweight patients, who are at higher risk for poor surgical outcomes. Further investigation is warranted to elucidate any causal relationship.