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Do Revisions in Rotator Cuff Repair Decline With GLP-1 Use?
Preoperative use was associated with fewer revisions and no increase in short-term complications among patients with obesity, although benefits appeared concentrated in select subgroups.
To evaluate the impact of preoperative glucagon-like peptide-1 receptor agonists on revision rates and complications in patients with obesity undergoing arthroscopic rotator cuff repair.
Approach:
Study Design: Retrospective analysis using the TriNetX electronic health record database to identify patients with obesity who underwent primary arthroscopic rotator cuff repair prior to June 2023.
Patient Matching: Patients receiving GLP-1 receptor agonists were propensity matched 1:1 with those who had never received the therapy, resulting in matched cohorts of 1,183 patients each.
Outcome Evaluation: Evaluated medical complications and emergency department utilization at 90 days, as well as retear, revision surgery, and conversion-to-arthroplasty rates at 1 and 2 years post-surgery.
Key Findings:
Lower revision rates for left-sided repairs in patients receiving GLP-1 receptor agonists: 2% at 1 year and 4% at 2 years compared to 7% and 8% in controls.
No significant differences in revision rates for right-sided repairs.
Lower retear rates among female patients undergoing left-sided repairs: 19% vs. 31% at 1 year and 20% vs. 34% at 2 years.
No significant differences in retear rates in the overall cohort or among male patients and right-sided repairs.
Short-term safety outcomes were similar between groups with no significant differences in complications.
Interpretation:
Limitations:
Retrospective study design with reliance on administrative coding data, which may lead to inaccuracies.
Lack of information on tear size, tissue quality, surgical technique, rehabilitation protocols, and imaging-confirmed healing.
A systematic review of more than 2.3 million patients found that women and men had different patterns of postoperative complications and recovery, with age and implant strategy modifying observed differences.
Researchers urge caution in interpreting joint replacement predictors, noting that surgery reflects access and decision-making as well as disease biology.