Impact Of Glucagon-like Peptide-1 Receptor Agonists Utilization on Outcomes of Midfoot and Hindfoot Fusions

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Foot and ankle fusions are complex procedures often performed in patients with comorbidities such as diabetes mellitus (DM), a condition linked to higher complication rates. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for managing DM and obesity, providing systemic benefits. However, their effect on foot and ankle surgery remains unclear. This study examines the influence of preoperative GLP-1 RA use on outcomes following midfoot, hindfoot and ankle arthrodesis. Methods: This retrospective study utilized the TriNetX database (2005–2025) to analyze two cohorts of patients undergoing open midfoot, hindfoot, or ankle fusions. The GLP-1 RA group (n = 958) included patients with preoperative GLP-1 RA use, while the control group (n = 33,081) had no prior GLP-1 RA use. Propensity score matching (1:1) controlled for demographics and comorbidities, yielding 947 patients per cohort. The GLP-1 RA cohort had a mean age of 57.1 years, BMI of 37.2 kg/m², and A1c of 6.98%. The control cohort had a mean age of 58.3 years, BMI of 36.1 kg/m², and A1c of 6.99%. Mean follow-up times were 844.0 days and 1,112.4 days, respectively. Results: At one year postoperatively, the GLP-1 RA group had lower risks of implant-related infection (RD: –0.011; 95% CI: –0.017 to –0.004) and stroke (RR: 0.435; 95% CI: 0.208–0.908). At two years, they had lower risks of implant infection, readmission (RR: 0.681; 95% CI: 0.502–0.923), ED utilization (RR: 0.698; 95% CI: 0.541–0.899), embolism, and thrombosis. At five years, they had lower risks of late implant infection and hardware failure. No significant differences were found in rates of hardware removal, nonunion/malunion, revision operation, or mortality. Conclusion: Preoperative GLP-1 RA use was associated with lower risks of various medical and mechanical complications following midfoot and hindfoot arthrodesis. Further research is needed to confirm these findings.