GLP-1 drugs linked to fewer post-surgical complications in diabetic patients

People with diabetes who were taking GLP-1 receptor agonist drugs such as tirzepatide and semaglutide had significantly lower rates of hospital readmission, wound re-opening and hematoma after surgery, according to a large study led by investigators at Weill Cornell Medicine, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian.

The study, published online in advance of print on Dec. 20 in the Annals of Surgery, analyzed de-identified hospital records covering 74,425 surgical procedures in 21,772 patients with diabetes over a three-and-a-half-year period ending in July 2023. The investigators found that patients taking GLP-1 receptor agonists, known informally as GLP-1 drugs, had about a 12% lower risk of hospital readmission within a month of surgery, a 29% lower risk of wound re-opening within six months of surgery, and about a 56% lower risk of hematoma (a collection of blood in tissue caused by bleeding) at the surgery site, compared with patients who were not taking such medications.

These findings from such a large number of patients and procedures suggest that taking these drugs shouldn't worsen overall post-surgical complications and may even reduce the likelihood of some of them."

Dr. Jason Spector, senior author, chief of the division of plastic and reconstructive surgery at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center and professor of surgery at Weill Cornell Medicine

Drug companies began developing GLP-1 drugs to treat diabetes in the early 1990s, and the first of them reached clinics in 2005. In 2014, the FDA approved their use to treat obesity. The drugs activate the GLP-1 receptor on cells in the pancreas and other organs, stimulating insulin release, which in turn lowers blood sugar and appetite.

The recent surge in use of GLP-1 drugs led Dr. Spector and first author Dr. Seth Aschen, then a plastic surgery resident at NewYork-Presbyterian/Weill Cornell Medical Center, to see if patients with diabetes undergoing surgery face more or fewer complications when taking them.

For their study, they and their colleagues examined de-identified electronic health records at NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian/Columbia University Irving Medical Center, including all surgical procedures on patients with diabetes from February 2020 to July 2023 for which there was at least six months of follow-up data. They recorded the rates of 30-day hospital readmissions and four other post-surgical adverse events during this follow-up period-comparing these rates among patients with and without active GLP-1 drug prescriptions. They also used a "propensity matching" system to line up patients taking GLP-1 drugs in each procedure with similar patients who weren't taking the drug, so that any differences in outcomes would be more likely to be related to use of the medications.

To the researchers' surprise, the results showed that the patients with diabetes who had GLP-1 drug prescriptions were modestly less likely to require hospital readmission within 30 days of surgery, implying fewer overall complications.

The researchers also looked at some specific complications: wound re-opening, hematoma, bleeding and infection. They found that while bleeding and infection occurred about as often whether or not the patients were taking GLP-1 drugs, hematoma and wound re-opening occurred markedly less often- patients on GLP-1 drugs in the 180 days following surgery had just 71.1% the risk of wound reopening and 44.0% of the risk of hematoma, compared with patients who did not have GLP-1 drug prescriptions.

Determining how GLP-1 drugs might exert such beneficial effects was beyond the scope of the study. However, diabetes is known to bring a higher risk of impaired wound healing. The investigators found that improved blood sugar control was unlikely to be mediating the positive effects on wound healing as the patients on the GLP-1 drugs had higher average blood sugar levels than the control patients. Other studies have found that the drugs may instead promote wound healing by preventing clotting, promoting blood vessel formation to help nourish tissues, lowering inflammation and other mechanisms, Dr. Spector noted.

He and his colleagues are currently performing similar analyses to see if GLP-1 drugs are associated with higher or lower risks of post-surgical complications in non-diabetic patients.