GLP-1 Drugs Did Not Increase Surgical Complications After Hip Fracture Repair in Diabetic Patients | Research

The takeaway

GLP-1 receptor agonist use was not associated with increased surgical or medical complications after hip hemiarthroplasty in diabetic patients, and may be linked to lower 1-year mortality.

No adverse outcomes linked to GLP-1RA use
After controlling for confounders, GLP-1 receptor agonist use was not associated with any increased postoperative complication in 499 diabetic hip fracture patients

What the researchers found

Among 499 diabetic patients undergoing hip hemiarthroplasty for femoral neck fractures, GLP-1RA use (n=248) was not associated with increased risk of any measured outcome compared to non-GLP-1RA users (n=251). Specifically, there was no increase in medical complications at 30, 90, or 365 days; no increase in surgical site infection, implant complications, or revision surgery; no increase in aspiration pneumonitis; and no difference in hospital length of stay or readmissions. GLP-1RA use was associated with decreased 365-day in-hospital mortality/hospice discharge. After controlling for confounders, no adverse outcome was associated with GLP-1RA use (all P>0.05).

Why it matters

As millions of patients take GLP-1 drugs, surgeons and anesthesiologists have worried about perioperative safety — particularly aspiration risk from delayed gastric emptying. This study provides real-world reassurance that GLP-1 drugs do not increase surgical complications in the high-risk setting of hip fracture surgery in elderly diabetic patients.

The numbers in context

n=499 (248 GLP-1RA, 251 controls) · no increased medical complications at 30, 90, or 365 days · no increased implant complications · no increased aspiration · decreased 365-day mortality/hospice discharge · all adverse outcomes P>0.05 after adjustment

How the study worked

Retrospective cross-sectional analysis of a hospital system database (2016–2023). Patients with T2DM aged 18+ who underwent hip hemiarthroplasty for femoral neck fractures were identified. GLP-1RA users (n=248) were compared to a 1:1 random matched sample of non-users (n=251). Elixhauser comorbidity index was recorded. Binary logistic regression assessed 30-day medical and 365-day implant outcomes.

Who was studied

499 adults with type 2 diabetes who underwent hip hemiarthroplasty for femoral neck fractures (2016–2023), with and without GLP-1 receptor agonist use

What this study cannot tell us

Single hospital system retrospective study with a relatively small sample. The 1:1 matching was random rather than propensity-based, which may leave residual confounding. The study could not determine specific GLP-1 agents or whether medications were held before surgery. Aspiration was measured as pneumonitis (clinical event) rather than subclinical aspiration.

How to read the evidence

Retrospective single-center study with random (not propensity) matching. While reasonably sized for this specific surgical population, the design cannot establish causation. The absence of adverse findings is reassuring but larger prospective studies would strengthen the evidence.

When this study was published

Published in 2025 using 2016–2023 data, this study directly addresses the current clinical debate about perioperative GLP-1 drug management.

The bigger picture

The perioperative management of patients on GLP-1 drugs is one of the most debated topics in anesthesiology. Several guidelines have recommended holding GLP-1 drugs before surgery due to aspiration concerns, but evidence has been limited. This study adds to growing data suggesting these concerns may be overstated, at least for hip fracture surgery.

Questions still open

Should current guidelines recommending GLP-1 drug cessation before surgery be revised based on accumulating safety data?
Does the lower 365-day mortality in GLP-1 users reflect a drug benefit or healthier baseline characteristics?
Would a larger multicenter study confirm these safety findings for other types of surgery?

Common questions

Why are surgeons worried about GLP-1 drugs during surgery?

GLP-1 drugs slow stomach emptying, which raises concern that patients might have food or liquid in their stomachs during anesthesia, increasing the risk of aspiration (inhaling stomach contents into the lungs). Some guidelines recommend stopping these drugs 1-2 weeks before planned surgery, though evidence for this recommendation has been limited.

Does this study mean it's safe to continue GLP-1 drugs before surgery?

This study found no increased complications in hip fracture patients on GLP-1 drugs, which is reassuring. However, hip fracture surgery is often urgent (patients can't stop medications in advance), so the findings may not apply to all elective surgeries. Patients should discuss perioperative medication management with their surgical team.

Read the original research

Effect of Glucagon-like Peptide-1 Receptor Agonists on Outcomes After Hip Hemiarthroplasty for Femoral Neck Fractures in Patients With Type 2 Diabetes.

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 9(10)

View on PubMed ↗

Citation

Box, McKenna W; Puga, Troy B; Werthmann, Neil J; Liu, Yingxian; Riehl, John T. (2025). Effect of Glucagon-like Peptide-1 Receptor Agonists on Outcomes After Hip Hemiarthroplasty for Femoral Neck Fractures in Patients With Type 2 Diabetes.. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 9(10).