JAAOS - 2026-04-21 - Journal Article
SGLT-2 Inhibitor Effects on Medical and Surgical Complication Rates After Total Shoulder Arthroplasty: A Propensity Matched Cohort Study.
Haj Shehadeh T, Boufadel P, Abboud JA
Topics
Key Takeaway
Diabetic TSA patients on SGLT-2 inhibitors had a 2.3-fold higher 90-day myocardial infarction rate compared to matched diabetic controls (2.03% vs 0.89%, P=0.001), with no difference in implant-related complications at 2 years.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study asked whether perioperative SGLT-2 inhibitor use affects complication rates in diabetic patients undergoing TSA, using the TriNetX database with 1:1 propensity score matching on demographics and comorbidities. The SGLT-2i cohort showed a significantly elevated 90-day MI rate (2.03% vs 0.89%, P=0.001) but no difference in ketoacidosis, thromboembolic events, AKI, wound complications, sepsis, or readmission. At 2 years, implant-related complication rates were equivalent between groups.
Key Limitation
The database cannot confirm whether SGLT-2 inhibitors were actually held perioperatively per current guidelines, meaning the MI signal may reflect either a drug effect or confounding by inadequate perioperative medication management.
Original Abstract
INTRODUCTION
Total shoulder arthroplasty (TSA) is being performed with increasing frequency and is projected to rise further in the coming years. Although generally successful, the procedure carries inherent risks. Diabetes is a well-established risk factor for postoperative complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective antidiabetic agents that are widely used; however, their perioperative safety in the setting of TSA has not yet been evaluated. The objective of this study was to assess the effect of perioperative SGLT2i use on 90-day medical complications and 2-year implant-related complications in diabetic patients undergoing TSA.
METHODS
The TriNetX database was queried to identify diabetic patients who underwent TSA. Patients were stratified according to SGLT2i prescription status, and 1:1 propensity score matching was done to adjust for relevant demographic and medical comorbidities. Outcomes of interest included 90-day medical and surgical complications and 2-year implant-related complications.
RESULTS
After propensity score matching, each cohort included 2,360 patients. The SGLT2i cohort demonstrated a significantly higher 90-day risk of myocardial infarction compared with control subjects (2.03% vs 0.89%, P = 0.001). No significant differences were observed between groups in the 90-day risk of ketoacidosis, deep vein thrombosis, pulmonary embolism, stroke, pneumonia, acute kidney injury, transfusion, wound disruption, sepsis, or hospital readmission. Similarly, there was no increased risk of implant-related complications at 2 years postoperatively in the SGLT2i cohort.
DISCUSSION
SGLT2i use was associated with an increased 90-day risk of myocardial infarction after TSA but appeared safe regarding implant-related outcomes. Additional research is warranted to clarify these associations; however, these findings may aid in preoperative counseling and optimization of surgical outcomes.
LEVEL OF EVIDENCE
III.