SGLT-2 Inhibitor Effects on Medical and Surgical Complication Rates After Total Shoulder Arthroplasty: A Propensity...

Area of Science:

• Orthopedic Surgery
• Cardiology
• Endocrinology

Background:

• Total shoulder arthroplasty (TSA) is increasingly common, with diabetes mellitus posing a risk for postoperative complications.
• Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are widely used antidiabetic medications.
• The perioperative safety of SGLT2i in TSA patients remains unevaluated.

Purpose of the Study:

• To evaluate the impact of perioperative SGLT2i use on 90-day medical and surgical complications.
• To assess the effect of perioperative SGLT2i use on 2-year implant-related complications in diabetic patients undergoing TSA.

Main Methods:

• A retrospective analysis of the TriNetX database identified diabetic patients who underwent TSA.
• Patients were stratified by SGLT2i prescription status and underwent 1:1 propensity score matching.
• Outcomes included 90-day medical/surgical complications and 2-year implant-related complications.

Main Results:

• After matching 2,360 patients per group, the SGLT2i cohort showed a significantly higher 90-day risk of myocardial infarction (2.03% vs. 0.89%, P=0.001).
• No significant differences were found in 90-day risks of ketoacidosis, VTE, stroke, pneumonia, AKI, transfusion, wound issues, sepsis, or readmission.
• No increased risk of 2-year implant-related complications was observed in the SGLT2i group.

Conclusions:

• Perioperative SGLT2i use is associated with an increased 90-day risk of myocardial infarction following TSA.
• SGLT2i use appears safe concerning implant-related outcomes at two years.
• Further research is needed; findings may inform preoperative counseling and patient optimization.