Title : Preoperative GLP-1 receptor agonist use on postoperative complications in adults with Type 2 Diabetes Mellitus (T2DM) undergoing operative ankle fracture repair: A systematic review
Abstract:
Introduction: Ankle fractures in adults with Type 2 Diabetes Mellitus (T2DM) are associated with increased postoperative complications. Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) have been proposed to mitigate complications and optimize surgical outcomes. To date, no systematic review of evidence on preoperative GLP-1 RA use and postoperative complications in this population exists.
Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources included PubMed, MEDLINE, Embase, and Cochrane Library from 2016 to 2026. Studies that reported on preoperative GLP-1 RA use and non-use associated with postoperative outcomes in adults with T2DM undergoing operative ankle fracture repair were included. Data quality was examined using the Newcastle-Ottawa Scale (NOS) for cohort studies. Certainty of evidence was assessed using the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework. A narrative synthesis was completed due to study heterogeneity.
Results: Three cohort studies met inclusion criteria and were analyzed. Preoperative GLP-1 RA use was associated with reduced Surgical Site Infections (SSI) in two studies, a 90-day decrease in cardiovascular events in one study, and reduced all-cause mortality in two studies; however, one study evaluated a combined GLP-1 RA/SGLT2i exposure, limiting attribution of SSI outcomes to GLP-1 RA alone. One study reported an association between GLP-1 RA use and fall-related injuries. Evidence for non-union, malunion, implant failure, and amputation was insufficient across studies.
Conclusion: Preoperative GLP-1 RA use may reduce postoperative infection, cardiovascular events, and mortality risk in adults with T2DM undergoing surgery for an ankle fracture, although evidence is limited and remains of low certainty. Further research is needed to evaluate the association between GLP-1 RA and fall-related injuries. Prospective high-quality studies with follow-up periods beyond one year are also warranted to further assess postoperative complications and long-term outcomes.
