Improved total shoulder arthroplasty outcomes associated with semaglutide utilization in patients with type II diabetes: a promising new addition to preoperative optimization.

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, P = .003), cardiac events (OR 0.32, P = .003), venous thromboembolism (OR 0.36, P = .001), pneumonia (OR 0.25, P < .001), urinary tract infection (OR 0.30, P < .001), acute kidney injury (OR 0.39, P < .001), and emergency department visit (OR 0.37, P < .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.