术前胰高血糖素样肽-1受体激动剂对大手术后结局的影响。
Impact of Preoperative Glucagon-Like Peptide-1 Receptor Agonist on Outcomes Following Major Surgery.
作者信息
Rashid Zayed, Woldesenbet Selamawit, Khalil Mujtaba, Altaf Abdullah, Kawashima Jun, Mumtaz Khalid, Pawlik Timothy M
机构信息
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA.
Department of Internal Medicine, Division of Palliative Care, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA.
出版信息
World J Surg. 2025 Mar;49(3):698-707. doi: 10.1002/wjs.12484. Epub 2025 Jan 9.
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.
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症的治疗。我们试图确定术前使用GLP-1RA对大型外科手术后结局的影响。
方法
使用IBM MarketScan数据库识别2013年至2021年间接受大型外科手术的患者。术前一年内使用GLP-1RA的患者被归类为“暴露组”。在倾向评分匹配（PSM）后，使用多变量回归分析来确定GLP-1RA暴露与术后并发症之间的关联。
结果
在138,980例患者中（冠状动脉搭桥术：n = 39,516，28.4%；肺切除术：n = 4,881，3.5%；腹主动脉瘤修复术：4,459，3.3%；胰腺切除术：n = 15,873，11.4%；结肠切除术：n = 74,251，53.4%），大多数个体为男性（n = 80,871，58.2%），中位年龄为58岁（IQR 53 - 61）。2944例（2.2%）个体在手术前有GLP-1RA暴露史。并发症的总体发生率为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%）或心肺功能衰竭（n = 26,661，19.2%）。在未匹配分析中，使用GLP-1RA的患者并发症风险更高（未使用GLP-1RA：36.3% vs. 使用GLP-1RA：44.5%，p < 0.）；然而，在进行PSM以考虑已测量的混杂因素后，GLP-1RA暴露与手术并发症的几率无关（OR 0.99，95% CI 0.91 - 1.08；p > 0.05）。在手术前2周内使用GLP-1RA的患者中（n = 522，17.7%），GLP-1RA与并发症风险无关（非近期使用GLP-1RA：44.7% vs. 近期使用GLP-1RA：44.1%；p = 0.992）。
结论
GLP-1RA的使用与大型外科手术后并发症风险增加无关。
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