Abstract
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-1 RAs) are widely used for managing type 2 diabetes and obesity. Beyond their metabolic effects, they have been shown to exhibit anti-inflammatory and cardiovascular protective properties, which may influence post-surgical recovery. However, the role of GLP-1 RAs in orthopedic procedures, particularly Achilles tendon repair, remains unclear. This study investigates whether GLP-1 RA use affects surgical outcomes, including wound infection, deep vein thrombosis (DVT)/pulmonary embolism (PE), hospital readmission, and reintervention. Given the rising prevalence of GLP-1 RA use, understanding its potential impact on surgical outcomes is essential for optimizing perioperative management. We hypothesized that GLP-1 RA use would be associated with a reduced incidence of post-operative complications, supporting its potential role in improving surgical recovery. METHODS: A retrospective cohort study was conducted on 337 patients who underwent Achilles tendon repair. Among them, 11.3% were GLP-1 RA users. Baseline characteristics, including age, sex, body mass index (BMI), diabetes status, and Charlson Comorbidity Index (CCI), were recorded. Post-operative complications, including wound infection, DVT/PE, readmission, and reintervention, were analyzed. Logistic regression models were used to estimate odds ratios (OR) for complications while controlling for potential confounders. Correlation analysis was performed to assess associations between GLP-1 RA use and surgical outcomes. Statistical significance was set at p < 0.05. Variance inflation factor (VIF) analysis was conducted to evaluate collinearity between independent variables. RESULTS: GLP-1 RA use was associated with a lower incidence of post-operative complications, with the most pronounced effect observed in wound infections. GLP-1 users had an 85% lower risk of wound infection compared to non-users (OR: 0.15, 95% CI: 0.03–0.67, p = 0.019), making non-GLP users 2.07 times more likely to develop a wound infection. Also, GLP-1 RA users had lower rates of DVT/PE (2.78% vs. 6.44%), readmission (2.78% vs. 7.80%), and reintervention (0.00% vs. 6.78%), though these differences did not reach statistical significance, likely due to the limited sample size. (Table 1 ) Diabetes emerged as the strongest predictor of wound infection (r = 0.29, p < 0.01), while age showed a negative correlation with wound infection (r = -0.12, p = 0.03). CONCLUSION: This study suggests that GLP-1 RA use is associated with a significantly lower risk of wound infection following Achilles tendon repair. Although GLP-1 RA users also had lower rates of DVT/PE, readmission, and reintervention, these differences were not statistically significant. These findings highlight a potential protective role of GLP-1 RAs in surgical outcomes, particularly in reducing post-operative wound infections. Larger prospective studies are needed to validate these associations and assess the potential integration of GLP-1 RAs into perioperative care to optimize recovery and minimize complications in orthopedic surgery.