JAAOS - 2026-04-03 - Journal Article
Preoperative GLP-1 Receptor Agonist Use and Postoperative Outcomes in Orthopaedic Surgery: A Scoping Review of Perioperative and Recovery Outcomes.
Strickler I, Jensen A, Cragg K, Dean R, McNassor R, Guettler J, Bicos J
Topics
Key Takeaway
Across 35 studies, preoperative GLP-1 RA use was associated with similar or lower 90-day complications in arthroplasty—including reduced PJI rates—while spine surgery showed mixed signals including increased pneumonia, AKI, and pseudarthrosis with prolonged semaglutide exposure.
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Summary
This scoping review following Arksey-O'Malley/JBI methodology and PRISMA-ScR reporting synthesized evidence from 35 studies (2015–2025) on preoperative GLP-1 RA exposure across arthroplasty, spine, trauma, foot/ankle, shoulder, and soft-tissue procedures. Arthroplasty cohorts consistently showed similar or lower 90-day complications, reduced PJI, shorter LOS, and fewer readmissions with GLP-1 RA use. Spine findings were heterogeneous, with some cohorts demonstrating lower infection and readmission but others showing increased pneumonia, AKI, and pseudarthrosis—particularly with prolonged semaglutide use.
Key Limitation
No included study standardized GLP-1 RA agent, dose, or perioperative hold duration, making it impossible to determine whether outcome differences are drug-class effects, dose-dependent, or confounded by indication.
Original Abstract
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.