Preoperative GLP-1 receptor agonist use is associated with lower 2-year emergency department utilization and all-cause mortality after total shoulder arthroplasty

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated metabolic, anti-inflammatory, and cardiovascular benefits, but their effect on outcomes following total shoulder arthroplasty (TSA) remains unclear. This retrospective cohort study used the TriNetX global database to evaluate the association between preoperative GLP-1 RA use and postoperative outcomes after TSA. Adult patients who underwent TSA between 2008 and 2022 were identified and stratified according to GLP-1 RA use within 30 days before surgery. One-to-one propensity score matching was performed to balance demographic characteristics and comorbidities. Outcomes included 90-day medical complications and 2-year surgical outcomes. In the matched 90-day cohort (1,951 patients), no significant differences were observed between groups in medical complications, readmission, emergency department utilization, or all-cause mortality. In the matched 2-year (1,917 patient) cohort, GLP-1 RA use was associated with significantly lower rates of emergency department utilization (26.7% vs. 31.0%; RR 0.86; 95% CI 0.78–0.95; p = 0.012) and all-cause mortality (1.8% vs. 4.3%; RR 0.43; 95% CI 0.29–0.63; p = 0.008). In summary, preoperative GLP-1 RA use was associated with favorable outcomes following TSA at 2-year follow-up. Given the observational nature of this study, these findings should be interpreted as associations and require validation in prospective studies.