Glucagon-Like Peptide-1 Agonists Confer no Additional Benefit during Bunion Correction Procedures with Regards to Complications and Adverse Effects

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Preoperative use of glucagon-like peptide-1 (GLP-1) agonist therapies has shown promising results for optimizing metabolic status in various surgical patient populations, and their utilization has continued to increase in recent years. While recent studies have demonstrated a reduction in risk of infection and readmission in patients taking GLP-1s following total knee and total hip arthroplasty, the impact of GLP-1 agonist exposure upon hallux valgus correction outcomes remains unclear. In this study, we aimed to determine whether perioperative GLP-1 medications influence short-term and long-term bunion correction procedure outcomes in matched patient cohorts. Methods: We conducted a retrospective analysis using the TriNetX research network, which aggregates deidentified electronic medical records from 105 healthcare organizations. Patients undergoing hallux valgus correction procedures were identified via CPT codes 28292, 28295-28299. Two cohorts were defined: patients with GLP exposure (via at least one GLP-related medication [lixisenatide, tirzepatide, semaglutide, liraglutide, or dulaglutide] within 60 days before or after surgery; n = 701) and those without GLP exposure (n = 56,618). Propensity score matching for age, sex, race, and type 2 diabetes mellitus yielded 701 matched pairs. Primary endpoints were any adverse event and individual complications including dehiscence, pulmonary embolism, deep vein thrombosis, transfusion, myocardial infarction, local infection, sepsis, and ER visit. Endpoints with ≤10 events in either group were excluded. Incidence rates, odds ratios (ORs), and p values were calculated for both the 90-day and 1-year time windows. Results: At 90 days, rate of any adverse event (AAE) was 9.6% in the GLP group versus 7.0% in controls (OR 1.41, 95% CI: 0.99–2.07; p = 0.081). Wound dehiscence occurred in 5.7% of GLP-exposed patients compared with 3.9% in controls (OR 1.51, 95% CI: 0.91–2.50; p = 0.104). At 1 year, rate of AAE was 12.3% versus 10.2% in the GLP group compared to control (OR 1.25, 95% CI: 0.94–1.67; p = 0.15), and wound dehiscence rates were 7.0% in the GLP group compared with 5.0% in controls (OR 1.45, 95% CI: 0.98–2.15; p = 0.12). Other complications, including deep vein thrombosis, pulmonary embolism, acute myocardial infarction, and infection, did not differ significantly at either 90 days or 1 year. Conclusion: Perioperative GLP exposure in hallux valgus correction patients was not associated with higher rates of overall adverse events and wound dehiscence at both 90 days and 1 year when compared to a matched cohort without GLP exposure. Our findings suggest that GLP therapies can be safely continued perioperatively in hallux valgus correction without a significant increase in postoperative complications. Further prospective studies are warranted to validate these results and to explore whether optimized GLP protocols might yield additional benefits in surgical outcomes.