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Description
Preoperative GLP-1 Receptor Agonist Use and Postoperative Outcomes in Orthopaedic Surgery: A Scoping Review of Perioperative and Recovery Outcomes
Introduction:
The rapid expansion of glucagon-like peptide-1 receptor agonist (GLP-1 RA) use for weight management and diabetes has raised perioperative questions, particularly regarding delayed gastric emptying and infection risk. Emerging real-world data suggest a more nuanced perioperative profile. This scoping review synthesizes evidence on preoperative GLP-1 RA exposure and postoperative outcomes across orthopaedic procedures, with emphasis on soft-tissue sports medicine, and is intended to map associative perioperative outcomes rather than establish causality.
Methods:
Following Arksey-O'Malley and Joanna Briggs Institute methodology and PRISMA-ScR reporting, we searched PubMed, Scopus, Web of Science, CINAHL Ultimate, Academic Search Premier, and Ovid Emcare (2015 to 2025). Eligible studies evaluated adult orthopaedic patients with documented GLP-1 RA use and postoperative outcomes. Three reviewers independently screened and extracted study characteristics, exposure timing, perioperative management, and outcomes.
Results:
Of 117 records screened, 35 studies met inclusion. Most were large retrospective cohorts spanning arthroplasty, spine fusion, trauma fixation, foot/ankle fusion, shoulder arthroplasty, and rotator cuff repair. Across hip, knee, and shoulder arthroplasty, GLP-1 RA use was generally associated with similar or lower 90-day complications, reduced periprosthetic joint infection, shorter length of stay, and fewer readmissions or revisions. Spine findings were mixed: Several cohorts showed lower infection and readmission, while others noted increased pneumonia, acute kidney injury, or pseudarthrosis in long-term semaglutide users. Trauma and ankle fracture cohorts showed no increase in short-term complications and in some cases lower mortality, with isolated signals for increased late fall-related injuries. Soft-tissue cohorts (rotator cuff repair and distal radius fixation) demonstrated fewer adverse events without increased aspiration or revision surgery risk. Functional outcomes (PROMIS) were rarely reported.
Conclusion:
Preoperative GLP-1 RA exposure is not broadly associated with increased postoperative risk and often correlates with lower infection, readmission, and mortality rates—particularly in arthroplasty, spine, and ankle fracture fixation cohorts. Findings in spine surgery are more mixed and warrant cautious interpretation, especially with prolonged semaglutide exposure. Outcomes in sports-medicine procedures seem reassuring, although prospective multicenter studies with standardized perioperative protocols and PROMIS-based outcomes are needed.
Learning Objectives
- Review the current evidence regarding preoperative GLP-1 receptor agonist use and its association with postoperative outcomes across common orthopaedic procedures.
- Evaluate the potential benefits and risks of perioperative GLP-1 receptor agonist use, including effects on infection rates, readmissions, complications, and recovery following orthopaedic surgery.
- Compare postoperative outcomes associated with GLP-1 receptor agonist use among arthroplasty, spine, trauma, foot and ankle, and sports medicine procedures, recognizing areas where evidence is consistent and where uncertainty remains.
- Apply current evidence to perioperative decision-making and patient counseling regarding GLP-1 receptor agonist management in orthopaedic surgical practice.
Director
Jonathan Grauer, MD, FAAOS
Co-Authors
Isabella Strickler, BA, Annabella Jensen, BS, Kyle Cragg, BS, Robert Dean, MD, Ryan McNassor, MD, Joe Guettler, MD, FAAOS, James Bicos, MD, FAAOS
The American Academy of Orthopaedic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
If you are unable to attend the live webinar, you may still register to be notified upon the availability of the recorded session. Access to the recording will be granted for a duration of 2 years.