Impact of Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes Following Ankle Fracture Open Reduction and Internal Fixation

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are quickly growing in popularity as effective tools in the management of diabetes and weight loss. Despite this increased usage, there is a paucity of literature investigating the use of GLP-1RA in patients with ankle fractures. This study aims to compare the outcomes of patients undergoing ankle fracture open reduction and internal fixation (ORIF) receiving therapy with GLP-1RA to those not receiving treatment. Methods: A retrospective analysis was performed utilizing the TriNetX research network to query patients who underwent ankle fracture ORIF between 2000-2024. Two cohorts were established according to preoperative GLP-1RA usage with 1:1 matching by propensity scores for demographics and comorbidities. Primary outcomes included the risk of postoperative complications at 30-days, 90-days, 1-year, and 5-years. Results: There were 123,546 patients not taking GLP-1RA and 1,173 patients taking GLP-1RA who underwent ORIF for an ankle fracture, with propensity score matching resulting in two cohorts of 1,173 patients each. After matching, there were no significant differences in demographics or comorbidities, including a 75.6% prevalence of diabetes mellitus and 68.7% prevalence of overweight or obesity in both cohorts. At 30-days postoperatively, the no GLP-1RA cohort had a significantly higher rate of removal of hardware (Odds Ratio [OR] 1.953, 95% Confidence Interval (CI) 1.062-3.591); no other complications demonstrated significant differences at 30-days, 90-days, 1-year, or 5-years postoperatively. Conclusion: Patients utilizing GLP-1RA preoperatively largely had no statistically significant increase in risk of postoperative complications following ankle fracture ORIF at 30-days, 90-days, 1-year, and 5-years postoperatively. Similarly, there was no difference in the rate of 5-year progression to post-traumatic ankle osteoarthritis with the use of GLP-1RA.These findings further underscore the low risk of preoperative GLP-1RA usage noted in other orthopaedic procedures.