SGLT-2 Inhibitor Effects on Medical and Surgical Complication Rates After Total Shoulder Arthroplasty: A Propensity Matched Cohort Study

INTRODUCTION: Total shoulder arthroplasty (TSA) is being performed with increasing frequency and is projected to rise further in the coming years. Although generally successful, the procedure carries inherent risks. Diabetes is a well-established risk factor for postoperative complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective antidiabetic agents that are widely used; however, their perioperative safety in the setting of TSA has not yet been evaluated. The objective of this study was to assess the effect of perioperative SGLT2i use on 90-day medical complications and 2-year implant-related complications in diabetic patients undergoing TSA. METHODS: The TriNetX database was queried to identify diabetic patients who underwent TSA. Patients were stratified according to SGLT2i prescription status, and 1:1 propensity score matching was done to adjust for relevant demographic and medical comorbidities. Outcomes of interest included 90-day medical and surgical complications and 2-year implant-related complications. RESULTS: After propensity score matching, each cohort included 2,360 patients. The SGLT2i cohort demonstrated a significantly higher 90-day risk of myocardial infarction compared with control subjects (2.03% vs 0.89%, P = 0.001). No significant differences were observed between groups in the 90-day risk of ketoacidosis, deep vein thrombosis, pulmonary embolism, stroke, pneumonia, acute kidney injury, transfusion, wound disruption, sepsis, or hospital readmission. Similarly, there was no increased risk of implant-related complications at 2 years postoperatively in the SGLT2i cohort. DISCUSSION: SGLT2i use was associated with an increased 90-day risk of myocardial infarction after TSA but appeared safe regarding implant-related outcomes. Additional research is warranted to clarify these associations; however, these findings may aid in preoperative counseling and optimization of surgical outcomes. LEVEL OF EVIDENCE: III.