Preoperative GLP-1 Receptor Agonist Use Is Not Associated With Complications in Non-Obese Patients Undergoing Total Shoulder Arthroplasty: A Propensity Score Matched Large Database Analysis

Background: As the demand for total shoulder arthroplasty (TSA) increases, it is imperative to optimize preoperative risk factors. While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are used for glycemic control or weight management in patients with obesity or diabetes, the impact of preoperative use on postoperative TSA outcomes in non-obese patients is unknown. Purpose: We sought to answer the question: Does preoperative use of GLP-1 RAs lead to increased risk of medical or surgical complications after TSA? Methods: We conducted a retrospective cohort study using data from the TriNetX Network to analyze non-obese patients (BMI <30 kg/m 2 ) who underwent anatomic or reverse shoulder arthroplasty between 2013 (the inception of the network) and January 2024 and had at least 1 year of follow up. Patients were categorized by preoperative GLP-1 RA use and matched 1:1 using propensity scores to balance the cohorts based on demographic variables and comorbidities. Outcomes assessed at 90 days and 1 year included revision surgery, emergency department visits, readmission, venous thromboembolism, pulmonary embolism, acute kidney injury, prosthetic joint stiffness, postoperative rotator cuff tear, dislocation, periprosthetic fracture or joint infection, surgical site infection, aspiration, cardiac arrest, and blood transfusion. Results: Among 108 352 non-obese patients, 845 used GLP-1 RAs preoperatively. After propensity score matching, 845 patients remained in each cohort with no significant baseline differences. In the 90 day postoperative period, there were no significant differences in any medical complications between the GLP-1 RA and control groups. Similarly, at 1 year, there were no significant differences in any medical or surgical complications between groups. Conclusion: This retrospective cohort study found that preoperative GLP-1 RA use in non-obese TSA patients was not associated with an increased rate of major postoperative medical or surgical complications. Level of Evidence: Level III: retrospective cohort study.