Key result
Perioperative SGLT2i use in diabetics undergoing shoulder arthroplasty linked to ~128% greater 90-day MI risk.
Why the study?
Diabetes increases postoperative complications after total shoulder arthroplasty, but the perioperative safety of SGLT2 inhibitors in this setting had not yet been evaluated.
Does perioperative SGLT2i use affect 90-day medical complications and 2-year implant-related complications in diabetic patients undergoing total shoulder arthroplasty?
Does perioperative SGLT2i use affect 90-day medical complications and 2-year implant-related complications in diabetic patients undergoing total shoulder arthroplasty?
Perioperative SGLT2 inhibitor use in diabetic patients undergoing total shoulder arthroplasty is associated with an increased 90-day risk of myocardial infarction, highlighting the need for careful preoperative optimization.
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.
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Shehadeh et al. (2026) studied this question. Perioperative SGLT2 inhibitor use in diabetic patients undergoing total shoulder arthroplasty significantly increased the 90-day risk of myocardial infarction (2.03% vs 0.89%, P=0.001).
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