Title : Preoperative GLP-1 receptor agonist use on postoperative complications in adults with type 2 diabetes mellitus 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-1RAs) have been found 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 currently 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 on 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, and the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework. A narrative synthesis was completed due to study heterogeneity.
Results: A total of three studies were analyzed. Preoperative GLP-1 RA use was associated with reduced Surgical Site Infections (SSI) in two studies. Two studies reported a significant reduction in all-cause mortality. One study found an increase in fall-related injuries. Evidence for non-union, malunion, implant failure, and amputation was insufficient among all studies.
Conclusion: Preoperative GLP-1 RA use may reduce postoperative infection and all-cause mortality risk in adults with T2DM undergoing surgery for an ankle fracture, although evidence is limited and remains at low certainty. Prospective high-quality studies with follow-up periods beyond one year are warranted to further assess postoperative complications and long-term outcomes.
