Impact of Perioperative Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes Following Carpal Tunnel Release.

Purpose: Glucagon-like peptide-1 receptor agonist (GLP-1RA) use continues to rise because of its efficacy in glycemic control and weight reduction. There are sparse data on the implications of GLP-1RA therapy on surgical outcomes. Given the higher prevalence of carpal tunnel syndrome in patients with diabetes mellitus, obesity, or both, this study evaluated the impact of perioperative GLP-1RA use on both short-term (90-day) and long-term (1-year) postoperative complications in patients undergoing carpal tunnel release (CTR). Methods: A retrospective cohort analysis was conducted with the TriNetX research database and identified all patients who underwent CTR at 95 health care organizations between 2004 and 2024. Two cohorts were stratified by perioperative GLP-1RA use and propensity score matched (1:1) to mitigate baseline differences in demographics, comorbidities, and procedural approach. Primary outcomes, including scarring, wound dehiscence, and infection, were evaluated over a 90-day postoperative period, whereas secondary outcomes, including subsequent CTR and median nerve (MN) injury, were assessed at the 1-year follow-up. Cohorts were compared using odds ratios (OR) with 95% confidence intervals (CI). Results: The query identified 303,360 patients who underwent CTR, including 13,439 on perioperative GLP-1RA therapy. After matching, homogeneous cohorts each consisted of 10,773 patients. At 90 days after surgery, the GLP-1RA cohort had significantly lower odds of wound dehiscence (OR, 0.691; 95% CI, 0.488-0.978) compared with patients not on GLP-1RA therapy. No significant differences were observed in rates of infection (superficial, deep, or unspecified), abscess incision and drainage, or scarring. At 1 year, GLP-1RA patients had lower odds of subsequent CTR (OR, 0.897; 95% CI, 0.839-0.959) and MN injury (OR, 0.399; 95% CI, 0.192-0.832). Conclusions: Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following CTR and did not increase the odds of any other 90-day postoperative complications. Additionally, GLP-1RA therapy demonstrated lower odds of subsequent CTR and MN injury at the 1-year follow-up. Prospective investigation is warranted to further clarify the impact of GLP-1RA therapy in patients undergoing CTR. Type of study/level of evidence: Prognostic III.