Grace Kim, BA OMS2¹; William H. Fang, DO²; Justin Chung, BS OMS2³; Evan Dunn, DO²; Rowen Lin, BS OMS2³; Kevin Mo, DO²; Daniel Lee, DO^2
1Western University of Health Sciences, Pomona CA
²Valley Hospital Medical Center Department of Orthopaedics, Las Vegas NV
³Touro University, Henderson NV

Abstract

Introduction
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly utilized for weight loss and metabolic optimization. While their benefits are documented in bariatric and cardiac surgery, their impact on orthopaedic surgical outcomes remains unclear. This systematic review aimed to evaluate perioperative and postoperative outcomes in orthopedic patients using GLP-1RAs compared to non-users.

Methods
A systematic review was conducted according to PRISMA guidelines. PubMed and Embase were searched through June 2025 to identify comparative cohort studies and randomized trials assessing GLP-1RA use in adult patient populations undergoing orthopaedic procedures (spine, knee, hip, or shoulder). Extracted data included reoperation, readmission, deep vein thrombosis (DVT), pulmonary embolism (PE), pneumonia, sepsis, and acute kidney injury (AKI).

Results
Across 24 retrospective cohort studies, differences in outcomes between GLP-1RA users and non-users were heterogeneous but generally favored GLP-1RA. Reoperation rates were lower in most studies, with absolute differences ranging from 4.6% fewer to 2.8% more procedures. Readmission rates also tended to be reduced in GLP-1RA groups, particularly after hip arthroplasty, with differences spanning 32.3% fewer to 2.9% more readmissions. Deep vein thrombosis occurred less frequently in GLP-1RA users in hip and shoulder arthroplasty, though some spine cohorts showed higher rates, with differences from 3.1% fewer to 1.1% more events. Pneumonia rates were likewise mixed, ranging from 7.4% fewer to 2.1% more cases, with consistent reductions in shoulder arthroplasty but occasional increases in spine and knee procedures. Overall, GLP-1RA use was most consistently associated with fewer reoperations and thromboembolic complications compared with non-users, whereas readmission and pneumonia outcomes varied by surgical population.

Conclusion
GLP-1RA use was associated with improved perioperative outcomes in orthopaedic surgery, particularly in reducing reoperation and readmission rates. These findings suggest potential metabolic and vascular benefits that translate into improved surgical outcomes. Further prospective studies are needed to clarify procedure-specific risks and support perioperative optimization strategies using GLP-1RAs.

Level of Evidence: IV

Keywords: GLP-1 receptor agonists; orthopaedic surgery; perioperative outcomes; arthroplasty; complications; systematic review 

List of Abbreviations: Glucagon-like peptide-1 receptor agonists (GLP-1RAs), type 2 diabetes mellitus (T2DM), deep vein thrombosis (DVT), pulmonary embolism (PE), acute kidney injury (AKI), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), myocardial infarction (MI), total hip arthroplasty (THA), total knee arthroplasty (TKA), total shoulder arthroplasty (TSA)

Introduction
Glucagon-like peptide-1 receptor agonists (GLP-1RA) are gut-derived incretin-mimetic hormones that slow gastric emptying, decrease gluconeogenesis, promote insulin secretion, increase satiety, and inhibit small bowel motility (Figure 1).^1,2 It was initially approved for the management of type 2 diabetes mellitus (T2DM), but has since gained popularity for its weight loss effects.³ As the use of GLP-1RAs increases, it is useful for surgical providers to understand the physiologic pharmacology and clinical implications of these therapies.⁴ 

Delayed gastric emptying associated with GLP-1RA users is a major perioperative concern, as it can increase gastric volume and potentially elevate the risk of aspiration during anesthesia or deep sedation⁵. On the other hand, GLP-1RAs offers important metabolic advantages in the perioperative setting, including improved glycemic control, reduced glucose variability, and lower insulin requirements^6,7. A meta-analysis by Watkins et al. demonstrated enhanced glycemic management with the use of GLP-1RA following coronary artery bypass grafting.⁸ Although these agents are well established in bariatric surgery and increasingly prescribed for obesity and metabolic disease, their expanding use across broader surgical populations necessitates greater awareness among surgeons in non-bariatric specialties.⁹

Despite this growing utilization, no existing systematic review in the literature has specifically assessed the use of GLP-1RA in the orthopaedic surgery context. Spine and arthroplasty procedures, given their high volume and clinical impact, are among the most frequently studied domains in orthopaedic outcomes research and provide a robust framework for evaluating perioperative risk and benefit.^10–13 Given this precedent aims to assess the perioperative risks and potential benefits of GLP-1RA therapy in patients undergoing orthopaedic procedures, with a focus on arthroplasty and spine surgery.

Methods

Study Design
This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Guidelines to compare GLP-1RA use in orthopedic procedures¹⁴. The primary objective of this study was to compare the perioperative and postoperative outcomes between patients using GLP-1RA versus those not receiving such therapies in orthopaedic surgeries, including arthroplasty and spine surgery. Spine and arthroplasty procedures are commonly studied in orthopaedic research due to their frequency and clinical significance, and are well represented in orthopaedic outcomes literature.^10–13

Search Strategy
A comprehensive systematic search was conducted in PubMed and Embase through June 2025, to identify relevant studies. The search strategy included combinations of the following terms: “GLP-1 receptor agonist”, “orthopaedic surgery”, “spine surgery”, “arthroplasty”, “arthroscopy” and “outcomes.” Reference lists of relevant articles were also manually screened to identify additional eligible studies.

Inclusion Criteria
Studies were eligible if they met the following criteria: (1) population: adult patients undergoing an orthopedic procedure; (2) intervention: use of a GLP-1RA (e.g., Semaglutide, Ozempic) by patient at the time of surgery ; (3) comparator: patients not taking a GLP-1RA; (4) outcomes: clinical outcomes including reoperation rates, readmission rates, emergency department visits, deep vein thrombosis, pulmonary embolism, myocardial infarction, pneumonia, sepsis, and acute kidney injury; (5) study design: randomized controlled trials or comparative cohort studies. Studies were excluded if: (1) they involved pediatric patients, (2) non-English language publications, or (3) non-comparative studies (e.g., single-arm, case series).

Literature Selection
Two independent reviewers screened all titles and abstracts for relevance. Full texts of potentially eligible studies were retrieved and reviewed in accordance with the inclusion and exclusion criteria. Disagreements were resolved by consensus or by consultation with a third reviewer. The study selection process was documented using the PRISMA flow diagram.

Data Analysis
Extracted data included study design, sample size, patient demographics, intervention and comparator details, clinical outcome measures (reoperation rates, readmission rates, emergency department visits), and postoperative complications (deep vein thrombosis, pulmonary embolism, myocardial infarction, pneumonia, sepsis, and acute kidney injury). Statistical values such as means, standard deviations, ranges, and p-values were also recorded.

Discrepancies in data extraction between reviewers were resolved through consensus discussion. Due to substantial heterogeneity in study design, surgical procedures, and outcome reporting across included studies, a meta-analysis was not feasible. Instead, outcomes were synthesized narratively and reported as mean differences, ranges, and p-values to identify comparative trends in perioperative and postoperative outcomes between GLP-1RA users and non-users.

Results
A total of 1,412 records were identified (PubMed = 982; Embase = 430). After removing 324 duplicates, 1,088 titles were screened, with 952 excluded. Of 136 full-text articles reviewed, 112 were excluded for ineligible design, population, language, or outcomes. Twenty-four studies published between 2023 and 2025 were included in the final systematic review.^15–38 This comprised of 1,084,425 patients (1,027,496 non-GLP-1RA users and 56,929 GLP-1RA users). (Figure 2)

The demographics of the patient population are summarized in Table 1. The most frequently studied procedures included spinal surgeries (11 studies), followed by total knee arthroplasty (6 studies), total hip arthroplasty (6 studies), and total shoulder arthroplasty (4 studies). Sample sizes varied considerably, ranging from as few as 66 GLP-1RA users to over 9,000 in the largest cohorts. Most studies employed follow-up periods ranging from 90 days to 24 months, with one study extending to five years.

Table 1. Study Characteristics: Characteristics included retrospective cohort studies evaluating postoperative outcomes following spine and joint arthroplasty procedures. Studies are organized by author and year, with details on procedure type, follow-up duration, patient population, and reported numbers of NGLP and GLP cases.

Reoperation Rates
GLP-1RA users were associated with lower reoperation rates across spinal surgery, TKA, and THA (Table 2). Among the 11 spinal studies, 4 reported reoperation rates and 3 demonstrated lower reoperation rates in GLP-1RA users. Similarly, 5 out of 6 TKA studies and 4 out of 5 THA studies also reported lower reoperation rates among GLP-1RA users. Among 2 studies reporting reoperation in TSA, 1 study found a benefit for GLP-1RA users.

Table 2. Reoperation Rate: Reported reoperation rates among retrospective cohort studies of spine and joint arthroplasty procedures. Rates are presented as percentages where available, stratified by NGLP and GLP groups; “n/a” indicates that data were not reported.

Readmission Rates
Readmission rates were generally lower among GLP-1RA users across most orthopaedic procedures (Table 3). Among the 7 spine studies that reported readmission outcomes, 4 found lower rates in GLP-1RA users. For TKA, 4 out of 5 studies reported higher readmission rates among non-users. All 4 THA studies evaluating readmission demonstrated improved outcomes for GLP-1RA users. Two out of 4 TSA studies showed higher readmission rates in non-GLP-1RA users.

Table 3. Readmission Rate: Reported readmission rates across retrospective cohort studies of spine and joint arthroplasty procedures. Rates are presented as percentages where available, stratified by NGLP and GLP groups; “n/a” indicates data were not reported.

Deep Vein Thrombosis (DVT)
The effects of GLP-1RA on DVT varied by procedure (Table 4). Among 4 spine studies evaluating DVT, 3 found higher rates in GLP-1RA users. Out of 5 TKA studies that reported DVT rates, 1 study found no difference, 2 showed higher DVT rates in non-GLP-1RA users, and 1 reported higher rates in GLP-1RA users. In TSA, 2 out of 3 studies indicated lower DVT rates among GLP-1RA users. In contrast, all 3 THA studies revealed higher DVT rates in the non-GLP-1RA users.

Table 4. DVT Rates: Reported rates of deep vein thrombosis (DVT) in retrospective cohort studies of spine and joint arthroplasty procedures. Rates are shown as percentages where available, stratified by NGLP and GLP groups; “n/a” indicates data were not reported

Pneumonia
Pneumonia outcomes demonstrated procedure-specific variability (Table 5). Among the 4 spine studies, 2 reported higher pneumonia rates in patients using GLP-1RA. Of 2 TKA studies, 1 reported higher pneumonia rates in GLP-1RA users. 3 out of the 4 TSA studies reported higher pneumonia rates in non-GLP-1RA users. In THA, pneumonia outcomes were mixed, 1 of the 2 studies reported higher pneumonia rates among GLP-1RA users.

Table 5. Pneumonia Rates: Reported rates of pneumonia in retrospective cohort studies of spine and joint arthroplasty procedures. Rates are presented as percentages where available, stratified by NGLP and GLP groups; “n/a” indicates data were not reported.

Discussion
GLP-1 receptor agonists, originally approved for glycemic control in T2DM, are now widely used for weight loss due to their gastrointestinal and metabolic effects. These physiological changes may influence perioperative risk profiles.^39,40 This systematic review compared the surgical and clinical outcomes of using GLP-1RA in orthopedic surgeries. Overall, GLP-1RA therapy was generally associated with lower rates of reoperation, readmission, and pulmonary embolism following orthopedic procedures. However, some studies reported higher rates of AKI, pneumonia, and DVT among GLP-1RA users, with variability depending on the procedure type.

The findings of this review suggest that GLP-1RA use may be associated with lower reoperation rates following spinal surgery, TKA, and THA. Specifically, three out of four spinal studies, five of six TKA studies, and four of five THA studies reported lower reoperation incidence in patients using GLP-1RAs. These results are consistent with emerging evidence that GLP-1RAs exert beneficial effects beyond glycemic control, including anti-inflammatory properties, improved metabolic function, and modulation of tissue repair mechanisms. GLP-1 analogs reduce inflammatory cytokines such as IL-1β, IL-6, and TNF-α, while also promoting wound healing through enhanced collagen deposition and expression of genes involved in epithelial protection and repair.^41,42 Similar trends have been shown in cardiac and general surgery populations, where GLP-1RA use has been associated with improved perioperative outcomes and shorter recovery times.^43,44 However, most of the included studies were observational in nature, and thus the overall level of evidence is low. Causality cannot be inferred, and prospective randomized controlled trials are needed to establish a definitive link between preoperative or perioperative GLP-1RA use and its potential as a component of risk reduction strategies in orthopaedic surgery.

Readmission rates were generally lower among GLP-1RA users, particularly in TKA, THA, and spine surgeries. A similar study by Buddhiraju et al. has reported significantly lower 90-day readmission rates and fewer postoperative complications among perioperative GLP-1RA users compared with non-users, supporting the hypothesis that GLP-1RA therapy may confer a protective effect in the surgical setting.⁴⁵ Similarly, Lee et al.’s systematic review found in a systematic review that perioperative GLP-1RA use was associated with reduced readmission rates following THA and TKA.⁴⁶ The present review builds upon these findings by stratifying outcomes across specific orthopaedic procedures and demonstrating consistent trends favoring GLP-1RA therapy in a broader, procedure-specific context.

The relationship between GLP-1RA use and postoperative thromboembolic events, particularly DVT, varied by procedure type. Spine surgery and TSA demonstrated higher DVT rates in GLP-1R users. THA studies showed lower rates of DVT in GLP-1RA users, while findings were mixed in TKA populations. These observations align with mechanistic and clinical data suggesting that certain GLP-1RAs, such as liraglutide, may exert cardiopulmonary and anti-inflammatory benefits, including improved endothelial function, enhanced vascular responsiveness, and attenuation of systemic inflammation, all of which could theoretically reduce thromboembolic risk.^47,48 However, given the heterogeneity of results and the observational nature of available data, these potential benefits are likely context-dependent, and large-scale, procedure-specific studies are required to clarify whether GLP-1RA use meaningfully reduces thromboembolic events in orthopaedic surgery.

Pneumonia outcomes among GLP-1RA users varied by procedure, with no consistent directional trend across all surgical categories. In spine and TKA surgeries, some studies found higher pneumonia rates among GLP-1RA users, whereas TSA and THA results were more favorable for non-users.  These inconsistencies may reflect differences in perioperative management, patient comorbidities, or the respiratory effects of GLP-1RAs. Delayed gastric emptying associated with GLP-1RA therapy may increase aspiration risk under anesthesia and thereby contribute to postoperative pneumonia in select patients, whereas improved glycemic control and reduced systemic inflammation might counterbalance this by lowering overall infection risk.⁴⁹ Given the small number of studies and variable findings, no definitive conclusion can be made. Given the limited number of studies and inconsistent findings, no definitive conclusions can be drawn, underscoring the need for prospective investigations with standardized assessment of aspiration and respiratory complications.

This review has several important limitations. Most included studies were retrospective cohort analyses, with inherent risks of selection bias, residual confounding, and variable adjustment for baseline comorbidities. Study designs, sample sizes, and follow-up durations were heterogeneous, and outcome definitions were not uniformly standardized across cohorts.  Additionally, GLP-1RA exposure was not consistently defined, there were differences in agent type, duration, dosage, or timing of medication were rarely specified. This limits the ability to assess dose-response relationships or drug-specific effects. Variability in perioperative management protocols and unmeasured confounders, such as nutritional status or concurrent medications, may further impact the generalizability of the findings. Despite these limitations, the aggregated data suggests a potential association between GLP-1RA use and reduced rates of reoperation and readmission following major orthopedic procedures highlighting the need for rigorously designed prospective studies.

In conclusion, this systematic review identifies a consistent association between GLP-1RA use and improved surgical outcomes in orthopaedic patients, particularly reduced reoperation and readmission rates after spine, knee, and hip procedures. While benefits GLP-1RA use were generalized observed in some studies for pulmonary embolism and deep vein thrombosis, the evidence was mixed for pneumonia and acute kidney injury were mixed, with variation by procedure type. These findings underscore the potential perioperative benefits of GLP-1RA therapy, but also raise important questions regarding patient selection, procedure-specific risks, and optimal perioperative management. Future prospective, controlled studies are essential to validate these associations, elucidate underlying mechanisms, and inform evidence-based guidelines for the safe and effective integration of GLP-1RA therapy into orthopaedic surgical care pathways.

Acknowledgements
n/a

Author contributions

• Grace Kim: Writing – Original Draft, Conceptualization, Visualization, Investigation. 
• William Fang: Writing- Reviewing and Editing, Methodology 
• Justin Chung: Methodology. 
• Evan Dunn: Data Curation. 
• Rowen Lin: Writing – Reviewing & Editing. 
• Kevin Mo: Writing- Reviewing and Editing. 
• Daniel Lee: Supervision.

Conflict of interest
The authors declare that they have no conflicts of interest relevant to the content of this manuscript.

Data availability statement
No new data were created or analyzed in this study. Data sharing is therefore not applicable to this article.

Ethical approval
This study is a systematic review of previously published data and did not involve direct patient contact or the collection of identifiable personal information. As such, institutional review board or ethics committee approval was not required.

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Informed consent
This study did not involve human subjects directly and relied exclusively on published aggregate data. Accordingly, informed consent was not required.

References

1. Horowitz M, Aroda VR, Han J, Hardy E, Rayner CK. Upper and/or lower gastrointestinal adverse events with glucagon-like peptide-1 receptor agonists: Incidence and consequences. Diabetes Obes Metab. 2017;19(5):672-681. doi:10.1111/dom.12872 
2. Aldawsari M, Almadani FA, Almuhammadi N, Algabsani S, Alamro Y, Aldhwayan M. The Efficacy of GLP-1 Analogues on Appetite Parameters, Gastric Emptying, Food Preference and Taste Among Adults with Obesity: Systematic Review of Randomized Controlled Trials. Diabetes Metab Syndr Obes. 2023;16:575-595. doi:10.2147/DMSO.S387116 
3. Blum D. What Is Ozempic and Why Is It Getting So Much Attention? Periód Bras Pesqui Científica. 2022;1(1):20-22. 
4. Xu D, Nair A, Sigston C, et al. Potential Roles of Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) in Nondiabetic Populations. Cardiovasc Ther. 2022;2022(1):6820377. doi:10.1155/2022/6820377 
5. Kaneko S, Ueda Y, Tahara Y. GLP1 Receptor Agonist Liraglutide Is an Effective Therapeutic Option for Perioperative Glycemic Control in Type 2 Diabetes within Enhanced Recovery After Surgery (ERAS) Protocols. Eur Surg Res. 2018;59(5-6):349-360. doi:10.1159/000494768 
6. Are Serious Anesthesia Risks of Semaglutide and Other GLP-1 Agonists Under-Recognized? Case Reports of Retained Solid Gastric Contents in Patients Undergoing Anesthesia. Anesthesia Patient Safety Foundation. Accessed July 3, 2025. https://www.apsf.org/article/are-serious-anesthesia-risks-of-semaglutide-and-other-glp-1-agonists-under-recognized/ 
7. Hulst AH, Visscher MJ, Godfried MB, et al. Liraglutide for perioperative management of hyperglycaemia in cardiac surgery patients: a multicentre randomized superiority trial. Diabetes Obes Metab. 2020;22(4):557-565. doi:10.1111/dom.13927 
8. Watkins AR, Fialka N, EL-Andari R, Kang JJ, Bozso SJ, Nagendran J. Effect of Glucagon-Like Peptide-1 Receptor Agonists Administration During Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Randomized Control Trials. Future Cardiol. 2023;19(2):105-115. doi:10.2217/fca-2022-0093 
9. Ihnat JMH, De Baun H, Carrillo G, Dony A, Mukherjee TJ, Ayyala HS. A systematic review of the use of GLP-1 receptor agonists in surgery. Am J Surg. 2025;240:116119. doi:10.1016/j.amjsurg.2024.116119 
10. Wang KY, Margalit A, Thakkar SC, et al. Reimbursement for Orthopaedic Surgeries in Commercial and Public Payors: A Race to the Bottom. JAAOS – J Am Acad Orthop Surg. 2021;29(23):e1232. doi:10.5435/JAAOS-D-20-01397 
11. Fares MY, Liu HH, da Silva Etges APB, et al. Utility of Machine Learning, Natural Language Processing,… : JBJS Reviews. Accessed July 7, 2025. https://journals.lww.com/jbjsreviews/fulltext/2024/08000/utility_of_machine_learning,_natural_language.11.aspx 
12. Lavoie-Gagne O, Nwachukwu BU, Allen AA, Leroux T, Lu Y, Forsythe B. Factors Predictive of Prolonged Postoperative Narcotic… : JBJS Reviews. Accessed July 7, 2025. https://journals.lww.com/jbjsreviews/fulltext/2020/06000/factors_predictive_of_prolonged_postoperative.10.aspx 
13. Hu ZC, He LJ, Chen D, et al. An enhanced recovery after surgery program in orthopedic surgery: a systematic review and meta-analysis. J Orthop Surg. 2019;14(1):77. doi:10.1186/s13018-019-1116-y 
14. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097 
15. Kim LY, Wiznia DH, Grauer JN. Patients With Diabetes on Sodium-Glucose Cotransporter-2 Inhibitors Undergoing Total Knee Arthroplasty Are at Increased Odds for a Number of Postoperative Adverse Events But Reduced Risk of Transfusion. J Am Acad Orthop Surg. Published online November 26, 2024. doi:10.5435/JAAOS-D-24-00299 
16. Ng MK, Mastrokostas PG, Mastrokostas LE, et al. Semaglutide use is associated with higher rates of pseudarthrosis and dysphagia in patients undergoing posterior cervical fusion. Spine J Off J North Am Spine Soc. Published online March 26, 2025:S1529-9430(25)00174-3. doi:10.1016/j.spinee.2025.03.023 
17. Agrawal V, Amasa S, Karabacak M, Margetis K. Perioperative Glucagon-Like Peptide-1 Agonist Use and Rates of Pseudarthrosis After Single-Level Lumbar Fusion: A Large Retrospective Cohort Study. Neurosurgery. 2024;97(1):91-97. doi:10.1227/neu.0000000000003291 
18. Goldman SN, Mani K, Scharfenberger T, et al. Glucagon-like peptide-1 receptor agonist use prior to spinal surgery results in reduced postoperative length of stay: A propensity-score matched analysis. North Am Spine Soc J NASSJ. 2025;22:100612. doi:10.1016/j.xnsj.2025.100612 
19. Wiener JM, Sanghvi PA, Vlastaris K, et al. Glucagon-Like Peptide-1 Receptor Agonist Medications Alter Outcomes of Spine Surgery: A Study Among Over 15,000 Patients. Spine. 2025;50(13):871-880. doi:10.1097/BRS.0000000000005283 
20. Chang Y, Lin HM, Chi KY, Song J, Atwan H. The impact of semaglutide on fusion rates following posterior lumbar fusion surgery in patients with type 2 diabetes. Int J Surg Lond Engl. Published online May 28, 2025. doi:10.1097/JS9.0000000000002492 
21. Vatsia SK, Levidy MF, Rowe ND, Meister AS, Bible JE. Fusion Outcomes of GLP-1 Agonist Therapy in Multilevel Cervical Spinal Fusion: A Propensity-Matched Analysis. Clin Spine Surg. 2025;38(4):213-216. doi:10.1097/BSD.0000000000001775 
22. Seddio AE, Gouzoulis MJ, Vasudevan RS, et al. Semaglutide utilization associated with reduced 90-day postoperative complications following single-level posterior lumbar fusion for patients with type II diabetes. Spine J Off J North Am Spine Soc. 2025;25(3):485-493. doi:10.1016/j.spinee.2024.10.011 
23. Ghali A, Lawand J, Mitchell P, et al. The Use of Semaglutide in Patients Undergoing Lumbar Fusion Does not Increase 90-Day Medical or 1-Year Implant Complications. Clin Spine Surg. Published online March 17, 2025. doi:10.1097/BSD.0000000000001800 
24. Tummala S, Gibbs DC, Chavarria J, Alder J, Avramis I, Rizkalla JM. GLP-1 receptor agonist use in elective lumbar spine surgery: Reduced pseudarthrosis rates and favorable safety profile. J Orthop. 2025;65:227-232. doi:10.1016/j.jor.2025.05.018 
25. Tao X, Ranganathan S, Van Halm-Lutterodt N, et al. No Difference in Short-term Surgical Outcomes From Semaglutide Treatment for Type 2 Diabetes Mellitus After Cervical Decompression and Fusion: A Propensity Score-matched Analysis. Spine. 2025;50(8):515-521. doi:10.1097/BRS.0000000000005099 
26. Khalid SI, Mirpuri P, Massaad E, et al. The impact of semaglutide use for weight loss on transforaminal lumbar interbody fusion outcomes. Clin Neurol Neurosurg. 2025;254:108952. doi:10.1016/j.clineuro.2025.108952 
27. Magruder ML, Yao VJH, Rodriguez AN, Ng MK, Sasson V, Erez O. Does Semaglutide Use Decrease Complications and Costs Following Total Knee Arthroplasty? J Arthroplasty. 2023;38(11):2311-2315.e1. doi:10.1016/j.arth.2023.05.071 
28. Magruder ML, Miskiewicz MJ, Rodriguez AN, Mont MA. Semaglutide Use Prior to Total Hip Arthroplasty Results in Fewer Postoperative Prosthetic Joint Infections and Readmissions. J Arthroplasty. 2024;39(3):716-720. doi:10.1016/j.arth.2023.12.023 
29. Seddio AE, Moran J, Gouzoulis MJ, et al. Lower Risk of Postoperative Complications and Rotator Cuff Retear Associated With Semaglutide Use in Patients with Type II Diabetes Mellitus Undergoing Arthroscopic Rotator Cuff Repair. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2025;41(2):199-206. doi:10.1016/j.arthro.2024.09.057 
30. Seddio AE, Wilhelm CV, Gouzoulis MJ, et al. Improved total shoulder arthroplasty outcomes associated with semaglutide utilization in patients with type II diabetes: a promising new addition to preoperative optimization. JSES Int. 2025;9(3):735-740. doi:10.1016/j.jseint.2024.10.006 
31. Verhey JT, Austin RP, Tarabichi S, et al. GLP-1 Agonists for Weight Loss: Do They Increase Complications in Non-diabetic Patients Undergoing Primary Total Hip Arthroplasty? J Arthroplasty. Published online March 11, 2025:S0883-5403(25)00224-4. doi:10.1016/j.arth.2025.03.012 
32. Magaldi RJ, Strecker SE, Witmer D. Glucagon-Like Peptide-1 Agonists in Total Hip Arthroplasty: Complications, Readmissions, and Patient-Reported Outcomes. JAAOS Glob Res Rev. 2024;8(11):e24.00148. doi:10.5435/JAAOSGlobal-D-24-00148 
33. Lawand JJ, Tansey PJ, Ghali A, et al. Glucagon-like peptide-1 receptor agonist use is associated with increased risk of perioperative complication and readmission following shoulder arthroplasty. J Shoulder Elbow Surg. 2025;34(5):1152-1157. doi:10.1016/j.jse.2024.09.012 
34. Buddhiraju A, Kagabo W, Khanuja HS, Oni JK, Nikkel LE, Hegde V. Decreased Risk of Readmission and Complications With Preoperative GLP-1 Analog Use in Patients Undergoing Primary Total Joint Arthroplasty. J Arthroplasty. 2024;39(12):2911-2915.e1. doi:10.1016/j.arth.2024.05.079 
35. Katzman JL, Haider MA, Cardillo C, Rozell JC, Schwarzkopf R, Lajam CM. Trends, Demographics, and Outcomes for Glucagon-Like Peptide-1 Receptor Agonist Use in Total Knee Arthroplasty: An 11-Year Perspective. J Arthroplasty. 2025;40(7S1):S176-S183. doi:10.1016/j.arth.2025.02.042 
36. Heo KY, Goel RK, Fuqua A, et al. Glucagon-Like Peptide-1 Receptor Agonist Use is Not Associated With Increased Complications After Total Knee Arthroplasty in Patients With Type-2 Diabetes. Arthroplasty Today. 2024;30:101506. doi:10.1016/j.artd.2024.101506 
37. Levidy MF, Vatsia S, Gohel N, et al. The Effects of Glucagon-Like Peptide-1 Agonist Therapy on Risk of Infection, Fracture, and Early Revision in Primary Total Joint Arthroplasty. J Am Acad Orthop Surg. Published online May 9, 2025. doi:10.5435/JAAOS-D-24-01284 
38. Elsabbagh Z, Haft M, Murali S, Best M, McFarland EG, Srikumaran U. Does use of glucagon-like peptide-1 agonists increase perioperative complications in patients undergoing shoulder arthroplasty? J Shoulder Elbow Surg. 2025;34(4):997-1006. doi:10.1016/j.jse.2024.07.045 
39. Singh S, Chandan S, Dahiya DS, et al. Impact of GLP-1 Receptor Agonists in Gastrointestinal Endoscopy: An Updated Review. J Clin Med. 2024;13(18):5627. doi:10.3390/jcm13185627 
40. do Nascimento TS, Pereira ROL, Maia E, et al. The impact of glucagon-like peptide-1 receptor agonists in the patients undergoing anesthesia or sedation: systematic review and meta-analysis. Perioper Med. 2024;13:78. doi:10.1186/s13741-024-00439-y 
41. Gatto A, Liu K, Milan N, Wong S. The Effects of GLP-1 Agonists on Musculoskeletal Health and Orthopedic Care. Curr Rev Musculoskelet Med. Published online May 15, 2025:1-12. doi:10.1007/s12178-025-09978-3 
42. Abdulmalik S, Ramos D, Rudraiah S, Banasavadi-Siddegowda YK, Kumbar SG. The glucagon-like peptide 1 receptor agonist Exendin-4 induces tenogenesis in human mesenchymal stem cells. Differ Res Biol Divers. 2021;120:1-9. doi:10.1016/j.diff.2021.05.001 
43. Klonoff DC, Kim SH, Galindo RJ, et al. Risks of peri- and postoperative complications with glucagon-like peptide-1 receptor agonists. Diabetes Obes Metab. 2024;26(8):3128-3136. doi:10.1111/dom.15636 
44. Aschen SZ, Zhang A, O’Connell GM, et al. Association of Perioperative Glucagon-like Peptide-1 Receptor Agonist Use and Postoperative Outcomes. Ann Surg. 2025;281(4):600-607. doi:10.1097/SLA.0000000000006614 
45. Buddhiraju A, Kagabo W, Khanuja HS, Oni JK, Nikkel LE, Hegde V. Decreased Risk of Readmission and Complications With Preoperative GLP-1 Analog Use in Patients Undergoing Primary Total Joint Arthroplasty. J Arthroplasty. 2024;39(12):2911-2915.e1. doi:10.1016/j.arth.2024.05.079
46. Lee V, Durkee SM, Ponce BA, Coutelle N, Gerges P, Lima D. Impact of Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes in Arthroplasty: A Systematic Review. J Arthroplasty. 2025;0(0). doi:10.1016/j.arth.2025.07.015 
47. Sp M, Gh D, K BF, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4). doi:10.1056/NEJMoa1603827 
48. Ma P, B C, R D, et al. Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome. N Engl J Med. 2015;373(23). doi:10.1056/NEJMoa1509225 
49. Chen YH, Zink T, Chen YW, et al. Postoperative Aspiration Pneumonia Among Adults Using GLP-1 Receptor Agonists. JAMA Netw Open. 2025;8(3):e250081. doi:10.1001/jamanetworkopen.2025.0081