Seddio Anthony E, Wilhelm Christopher V, Gouzoulis Michael J, Islam Wasif, Vasudevan Rajiv S, Halperin Scott J, Rubin Lee E, Medvecky Michael J, Donohue Kenneth W, Grauer Jonathan N
Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA.
JSES Int. 2024 Nov 14;9(3):735-740. doi: 10.1016/j.jseint.2024.10.006. eCollection 2025 May.
Semaglutide (the active agent in Ozempic [Novo Nordisk, Plainsboro, NJ, USA]) has been increasingly recognized as one of the most effective medications in the management of type II diabetes mellitus (T2DM). Patients with T2DM undergoing orthopedic surgery, such as total shoulder arthroplasty (TSA), may be using this medication for management of their disease. While T2DM has been associated with inferior postoperative TSA outcomes, the correlation of preoperative semaglutide use on such outcomes has never been characterized.
T2DM patients undergoing TSA (anatomic or reverse) were identified from the PearlDiver M165Ortho database using administrative coding. T2DM patients who utilized semaglutide within 1 year before TSA were identified and matched 1:4 with T2DM patients who did not based on age, sex, Elixhauser Comorbidity Index, end-organ diabetes complications, body mass index, tobacco, insulin, and metformin use. Incidence of 90-day adverse events were compared by univariable and multivariable analyses.
After matching, there were 632 T2DM +semaglutide and 2302 T2DM -semaglutide patients. On multivariable analysis of the matched populations, T2DM +semaglutide patients had significantly lower odds of surgical site infection (odds ratio (OR) 0.25, = .003), cardiac events (OR 0.32, = .003), venous thromboembolism (OR 0.36, = .001), pneumonia (OR 0.25, < .001), urinary tract infection (OR 0.30, < .001), acute kidney injury (OR 0.39, < .001), and emergency department visit (OR 0.37, < .001).
The current study encouragingly found reductions in 90-day adverse outcomes following TSA for patients with T2DM using semaglutide preoperatively. Further prospective analysis is warranted as the observed findings suggest clinical benefit of semaglutide integration into preoperative optimization pathways by the studied patient population.
司美格鲁肽（诺和泰 [诺和诺德公司，美国新泽西州普兰斯伯勒] 中的活性成分）已日益被视为治疗2型糖尿病（T2DM）最有效的药物之一。接受骨科手术（如全肩关节置换术 [TSA]）的T2DM患者可能正在使用这种药物来控制病情。虽然T2DM与较差的术后TSA结果相关，但术前使用司美格鲁肽与此类结果的相关性从未得到明确。
使用管理编码从PearlDiver M165Ortho数据库中识别接受TSA（解剖型或反置型）的T2DM患者。识别出在TSA前1年内使用司美格鲁肽的T2DM患者，并根据年龄、性别、埃利克斯豪泽合并症指数、终末器官糖尿病并发症、体重指数、吸烟情况、胰岛素和二甲双胍使用情况，将其与未使用司美格鲁肽的T2DM患者按1:4进行匹配。通过单变量和多变量分析比较90天不良事件的发生率。
匹配后，有632例T2DM +司美格鲁肽患者和2302例T2DM -司美格鲁肽患者。在对匹配人群进行多变量分析时，T2DM +司美格鲁肽患者发生手术部位感染（比值比 [OR] 0.25，P = .003）、心脏事件（OR 0.32，P = .003）、静脉血栓栓塞（OR 0.36，P = .001）、肺炎（OR 0.25，P < .001）、尿路感染（OR 0.30，P < .001）、急性肾损伤（OR 0.39，P < .001）和急诊就诊（OR 0.37，P < .001）的几率显著降低。
本研究令人鼓舞地发现，术前使用司美格鲁肽的T2DM患者在TSA后90天不良结局有所减少。鉴于观察结果表明所研究的患者群体将司美格鲁肽纳入术前优化途径有临床益处，因此有必要进行进一步的前瞻性分析。
