"Examining the Impact of Perioperative Glucagon-Like-Peptide-1 use within Foot and Ankle Surgery: A Systematic Review of Comparative Studies”

BACKGROUND: Patients undergoing foot and ankle surgery often have comorbidities such as diabetes, obesity, and vascular disease, increasing their risk of postoperative complications. With the growing use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), understanding their perioperative impact is increasingly important. PURPOSE: This systematic review evaluated outcomes associated with GLP-1 RA use prior to foot and ankle surgery. STUDY DESIGN: Systematic review. METHODS: PubMed, EMBASE, and CINAHL were queried from inception through November 2025. A narrative synthesis was performed, and descriptive statistics were reported using frequency-weighted means. RESULTS: A total of 5,520 patients across three comparative studies were included. The cohort was 65.96% female (n=3,641), with a mean age of 55.09 ± 14.65 years, and 76.67% (n=4,232) had a BMI >30. Most patients (71.63%, n=3,954) underwent open reduction and internal fixation for ankle fractures, while the remainder underwent arthrodesis for degenerative pathology. GLP-1 RA use was generally associated with neutral or improved perioperative outcomes. Findings included lower rates of pseudarthrosis following subtalar and triple arthrodesis and reduced early hardware removal after ankle fracture fixation. Some studies also demonstrated decreased odds of medical complications, including infection, deep vein thrombosis, and myocardial infarction, while others found no significant differences. CONCLUSION: GLP-1 RAs appear to have a neutral to potentially favorable perioperative profile in foot and ankle surgery. However, conclusions are limited by the small number of studies and their retrospective design, underscoring the need for higher-quality prospective research.