Impact of Preoperative Glucagon-Like Peptide-1 Receptor Agonist on Outcomes Following Major Surgery.

IF 2.3 3区医学 Q2 SURGERY

World Journal of Surgery Pub Date : 2025-01-09 DOI:10.1002/wjs.12484

Zayed Rashid, Selamawit Woldesenbet, Mujtaba Khalil, Abdullah Altaf, Jun Kawashima, Khalid Mumtaz, Timothy M Pawlik

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引用次数: 0

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly being used for the management of diabetes mellitus and obesity. We sought to define the impact of preoperative GLP-1RA use on outcomes following major surgical procedures.

Methods: Patients who underwent a major surgical procedure between 2013 and 2021 were identified using the IBM MarketScan database. Patients who took GLP-1RA within a year before surgery were categorized as "exposed." After propensity score matching (PSM), multivariable regression analysis was used to define the association of GLP-1RA exposure with postoperative complications.

Results: Among 138,980 patients (coronary artery bypass graft: n = 39,516, 28.4%; pneumonectomy: n = 4,881, 3.5%; abdominal aortic aneurysm repair: 4,459, 3.3%; pancreatectomy: n = 15,873, 11.4%; and colectomy: n = 74,251, 53.4%), most individuals were male (n = 80,871, 58.2%) with a median age of 58 (IQR 53-61) years. 2944 (2.2%) individuals had GLP-1RA exposure before surgery. Overall incidence of complications was 36.5% (n = 50,724); complications included sepsis (n = 6,385, 4.6%), surgical site infections (n = 7,431, 5.3%), thromboembolism (n = 3,609, 2.6%), pneumonia (n = 4,783, 3.4%), renal (n = 9,017, 6.5%), or cardiopulmonary failure (n = 26,661, 19.2%). On unmatched analysis, patients on GLP-1RA had a higher risk of complications (no GLP-1RA: 36.3% vs. GLP-1RA: 44.5% p < 0.001); however, after PSM to account for measured confounders, GLP-1RA exposure was not associated with the odds of surgical complications (OR 0.99 95% CI 0.91-1.08; p > 0.05). Among patients using GLP-1RA during the 2 weeks before surgery (n = 522, 17.7%), there was no association of GLP-1RA with risk of complications (nonrecent GLP-1RA: 44.7% vs. recent GLP-1RA: 44.1%; p = 0.992).

Conclusions: GLP-1RA use was not associated with an increased risk of complications following major surgical procedures.

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术前胰高血糖素样肽-1受体激动剂对大手术后预后的影响。

背景：胰高血糖素样肽-1受体激动剂（GLP-1RA）越来越多地用于糖尿病和肥胖的治疗。我们试图确定术前使用GLP-1RA对大手术后预后的影响。方法：使用IBM MarketScan数据库确定2013年至2021年期间接受重大外科手术的患者。术前一年内服用GLP-1RA的患者被归类为“暴露”。倾向评分匹配（PSM）后，采用多变量回归分析确定GLP-1RA暴露与术后并发症的关系。结果：138,980例患者中(冠状动脉旁路移植术：n = 39,516例，占28.4%；全肺切除术：n = 4,881, 3.5%；腹主动脉瘤修复：4459例，3.3%；胰腺切除术：15873例，11.4%；和结肠切除术：n = 74,251, 53.4%)，大多数患者为男性（n = 80,871, 58.2%），中位年龄58 （IQR 53-61）岁。2944人（2.2%）在手术前接触过GLP-1RA。总并发症发生率为36.5% (n = 50,724)；并发症包括败血症（n = 6,385, 4.6%）、手术部位感染（n = 7,431, 5.3%）、血栓栓塞（n = 3,609, 2.6%）、肺炎（n = 4,783, 3.4%）、肾脏（n = 9,017, 6.5%）或心肺衰竭（n = 26,661, 19.2%）。在非匹配分析中，GLP-1RA组患者出现并发症的风险更高（未使用GLP-1RA组：36.3% vs. GLP-1RA组：44.5% p 0.05）。在手术前2周内使用GLP-1RA的患者中（n = 522, 17.7%）， GLP-1RA与并发症风险无相关性(非近期GLP-1RA: 44.7% vs近期GLP-1RA: 44.1%；p = 0.992)。结论：GLP-1RA的使用与重大外科手术后并发症的风险增加无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgery 医学-外科

CiteScore

5.10

自引率

3.80%

发文量

460

审稿时长

3 months

期刊介绍： World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.