Comparative post-operative outcomes in glucagon-like peptide-1 receptor agonist users vs. non-users following total shoulder arthroplasty: A systematic review and meta-analysis

Background Multiple studies in knee and hip arthroplasty populations have reported favorable perioperative complication profiles among patients receiving glucagon-like peptide-1 receptor agonists (GLP-1 RAs). However, evidence in shoulder arthroplasty remains conflicting, and no comprehensive review has evaluated their impact in this population. This study aimed to synthesize current evidence on the association between GLP-1 RA use and short- and mid-term perioperative complications following shoulder arthroplasty. Methods A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, including studies comparing post-operative complication rates between GLP-1RA users and nonusers undergoing total or reverse shoulder arthroplasty. Pooled analyses were performed with a random-effects model. Results were reported as odds ratios with 95% confidence intervals, and between-study heterogeneity was quantified using the I 2 statistic. Results Five studies (n = 40,005) met inclusion criteria, including 7,924 (19.8%) GLP-1RA users. Across 90-day outcomes, no significant differences were observed for readmission, deep vein thrombosis, pulmonary embolism, pneumonia, or surgical site infection. Sepsis was the only complication demonstrating a significant reduction among GLP-1RA users (odds ratio, 0.65; 95% confidence interval, 0.44-0.96; P = .03). Heterogeneity ranged from low to high across these endpoints ( I 2 = 21.3%-90.4%). At 2 years, no differences were observed in all-cause revision, periprosthetic joint infection, or periprosthetic fracture, with consistently low to moderate heterogeneity ( I 2 = 0%-36.2%). Discussion Across more than 40,000 total shoulder arthroplasty (TSA) patients, GLP-1RA use was not associated with differences in 90-day or 2-year complications, except for a lower rate of sepsis among GLP-1RA users. These findings suggest that GLP-1RA continuation may not increase perioperative risk in TSA. Differences from hip and knee arthroplasty studies may reflect the lower baseline risk profile and comorbidity burden of TSA patients. Further prospective studies are needed to confirm these results and guide perioperative management as GLP-1RA use expands.