Preoperative use of glucagon-like peptide-1 receptor agonists may lower revision rates without increasing short-term complications among patients with obesity undergoing arthroscopic rotator cuff repair.
In a study, investigators used the TriNetX electronic health record database to identify patients with obesity who underwent primary arthroscopic rotator cuff repair prior to June 2023 and had at least 2 years of follow-up. Patients who received a glucagon-like peptide (GLP)-1 receptor agonist within 1 year prior to surgery were propensity matched 1:1 with patients who had never received the therapy. The final matched cohorts both included 1,183 patients. The investigators evaluated medical complications and emergency department utilization at 90 days as well as retear, revision surgery, and conversion-to-arthroplasty rates at 1 and 2 years postsurgery.
The investigators found lower revision rates following left-sided repairs among the patients receiving GLP-1 receptor agonists. At 1 and 2 years, the revision rates were a respective 2% and 4% among those receiving GLP-1 receptor agonists compared with 7% and 8% among matched controls. No statistically significant differences in revision rates were observed following right-sided repairs.
There were no statistically significant differences in retear rates in the overall cohort. However, subgroup analyses identified lower retear rates among female patients undergoing left-sided repairs. At 1 year, retears occurred in 19% of the patients receiving GLP-1 receptor agonists compared with 31% of matched controls. At 2 years, the rates were 20% and 34%, respectively. Similar differences were not observed among male patients or among those undergoing right-sided repairs.
The investigators also performed a separate analysis among the patients with type 2 diabetes. In that cohort, GLP-1 receptor agonist use was not associated with statistically significant differences in retear or revision rates.
The short-term safety outcomes were similar between groups. The investigators found no statistically significant differences in the rates of acute kidney injury, pneumonia, venous thromboembolism, urinary tract infection, cardiac events, sepsis, superficial surgical-site infections, or readmission within 90 days of surgery. Emergency department utilization also did not differ significantly between groups.
In an accompanying editorial, Jay Moran, MD, of Yale School of Medicine, and Andrew E. Jimenez, MD, both of the Yale School of Medicine, wrote that the study's most important implication was that the effects of GLP-1 receptor agonists may not be uniform across all patients with obesity undergoing arthroscopic rotator cuff repair. They noted that the observed benefits appeared concentrated in specific patient subgroups and cautioned that population-level conclusions may obscure clinically meaningful differences between patients who derive benefit and those who do not.
The investigators acknowledged several limitations. The study was retrospective and relied on administrative coding data, creating the potential for coding inaccuracies and unmeasured confounding. The database also lacked information on tear size, tissue quality, surgical technique, rehabilitation protocols, and imaging-confirmed healing. In addition, the observed benefits were largely limited to left-sided repairs, a finding the investigators suggested may reflect coding limitations inherent to large database studies.
Overall, the findings suggested that preoperative GLP-1 receptor agonist use may be safe among patients with obesity undergoing arthroscopic rotator cuff repair and may be associated with lower revision rates and lower retear rates in select subgroups.
“GLP-1 [receptor agonists] appear to be generally safe for preoperative use in patients [with obesity] undergoing [arthroscopic rotator cuff repair] and were associated with decreased rates of revision and retear in certain subgroups,” wrote lead study author Argen Omurzakov, BA, of Case Western Reserve University School of Medicine, and colleagues.
Full disclosures of the study and authors and editorial authors can be found in the study and editorial commentary.
Source: Arthroscopy, Editorial
