Association between pre‐operative sodium‐glucose cotransporter‐2 inhibitor use and postoperative outcomes: a propensity score‐matched analysis of the TriNetX database

Summary Introduction While sodium‐glucose cotransporter‐2 inhibitors offer cardiovascular and renal benefits, their peri‐operative safety and effect profile remain unclear. This study aimed to evaluate the association between pre‐operative sodium‐glucose cotransporter‐2 inhibitor use and postoperative adverse events in patients with type 2 diabetes mellitus. Methods This nationwide propensity‐score matched cohort study utilised the TriNetX database to analyse data from patients with type 2 diabetes mellitus who underwent surgery in the USA. Patients were categorised based on whether they had received a prescription for sodium‐glucose cotransporter‐2 inhibitors 90 days before surgery. The primary outcome was 30‐day all‐cause mortality. Secondary outcomes included the incidence of major adverse cardiovascular events; acute kidney injury; and diabetic ketoacidosis. Results In 98,118 matched pairs, 30‐day all‐cause mortality was significantly lower in patients in the sodium‐glucose cotransporter‐2 inhibitor group compared with those in the control group (RR 0.61, 95%CI 0.55–0.67, p < 0.001). Patients receiving sodium‐glucose cotransporter‐2 inhibitor treatment also showed lower risks of major adverse cardiovascular events (RR 0.89, 95%CI 0.86–0.91); acute kidney injury (RR 0.71, 95%CI 0.69–0.74); and diabetic ketoacidosis (RR 0.31, 95%CI 0.18–0.540) (p < 0.001 for all comparisons). Subgroup analyses revealed a more pronounced reduction in mortality among females, patients living with obesity or proteinuria, and those undergoing cardiovascular surgery. Discussion Our study showed a significantly reduced risk of postoperative mortality and morbidity associated with pre‐operative sodium‐glucose cotransporter‐2 inhibitor use in patients with type 2 diabetes mellitus, including a notably lower rate of diabetic ketoacidosis, contrary to previous concerns. Randomised controlled trials are warranted to validate these findings.