In a major new study, international healthcare professionals can take reassurance from findings that glucagon-like peptide-1 (GLP-1) agonists do not raise the risk of complications following total shoulder arthroplasty (TSA). This news‐style report explains the research and its implications in everyday language.
It highlights an emerging debate on the perioperative safety of GLP-1 agonists in orthopaedic surgery , a topic growing in importance as the use of these drugs rises worldwide.
GLP-1 receptor agonists, once used mainly to manage type 2 diabetes, are now widely prescribed for weight loss too. They include drugs such as semaglutide and liraglutide. Their popularity has soared because they improve blood sugar control and support significant weight loss.
However, these drugs also slow gastric emptying, which raises questions about whether they might increase risks during and after surgery , especially for procedures like shoulder replacements where anaesthesia and digestive response matter.
Earlier studies have linked GLP-1 drugs to gastrointestinal effects and possible aspiration concerns during procedures.
Researchers examined data from 2,219 adults who underwent primary TSA between 2015 and 2023. They compared two groups: 449 patients taking GLP-1 agonists before surgery, and 1,770 matched control patients with no history of GLP-1 use.
The matching helped control for age, health status, and other important factors. Investigators scanned clinical records using natural language processing (NLP) , a computer method that reads and classifies clinical notes , to find mentions of nausea, vomiting, aspirations, and other complications.
Unlike insurance-only databases, this approach allowed researchers to capture case-specific details directly from physician documentation.
The most striking result was that GLP-1 agonist use did not increase risk of: Perioperative nausea or vomiting. Lung aspirations during or immediately after surgery. Postoperative complications such as joint infection, hardware failure, fracture, nerve injury or need for revision surgery within one year.
Moreover, these findings held up even after adjusting for patient demographics and comorbidities. In fact, there was no significant difference between the GLP-1 and non-GLP-1 groups for any of these outcomes.
For patients and clinicians , where joint replacement surgery is common and GLP-1 agonists are increasingly prescribed , these results are reassuring. They suggest that continuing GLP-1 therapy does not appear to raise the risk of gastrointestinal or other complications around the time of shoulder arthroplasty.
Orthopaedic surgeons can use these findings to inform preoperative counselling. Until now, clinicians have often relied on insurance claims data or smaller studies to make decisions about managing GLP-1 use before surgery. This study stands out because it directly analysed physician documentation from multiple hospitals, making its conclusions potentially more clinically relevant.
It’s important to put these findings in context. Other research on GLP-1 agonists and joint surgery has shown mixed results:
A large US-based cohort study linked GLP-1 use with higher rates of deep vein thrombosis, pneumonia and readmission after shoulder arthroplasty.
Another nationwide analysis found no increased 90-day major complication rates or longer hospital stays in patients on GLP-1 therapy undergoing TSA.
Meta-analyses focusing on joint replacement more broadly (hips and knees) often report either reduced infection or readmission rates, or no increase in other complications with GLP-1 agonist use.
A separate large database study in obese shoulder arthroplasty patients found no difference in complications up to one year after surgery between GLP-1 users and controls.
Taken together, these studies suggest that GLP-1 agonists are not inherently dangerous in the surgical setting, but the evidence isn’t yet universal. Researchers caution that patient selection, surgical technique, and drug dosing all play roles.
Despite the reassuring results, some anaesthetists remain cautious because GLP-1 agonists slow stomach emptying, which theoretically could increase aspiration risk, when stomach contents enter the lungs during anaesthesia.
A recent review of perioperative sedation and anaesthesia supports this concern, reporting increased gastrointestinal symptoms in people on GLP-1 drugs.
Because aspiration can be serious, some anaesthesia guidelines suggest tailored fasting or even temporary cessation of GLP-1 drugs ahead of surgery , though such practice varies. Further research is needed to define the safest protocols, especially for high-risk patients.
GLP-1 agonists safety in shoulder surgery appears to be increasingly supported by evidence. The new study used advanced NLP methods and real medical records. It found no increased harm for people taking these drugs before total shoulder arthroplasty.
It adds to a growing body of research supporting the perioperative safety of GLP-1 agonists.
For clinicians and patients, this offers valuable insight into one of the fastest-growing classes of medications in diabetes and weight management, reassuring them that these drugs don’t automatically translate to higher surgical risk in the shoulder replacement setting.
Sources:
- Amen, T. B., Liimakka, A., Rudisill, S., Dean, M., Torabian, K., & Dyer, G. (2026). GLP-1 agonists and total shoulder arthroplasty outcomes: Using natural language processing to assess postoperative risks and complications. Seminars in Arthroplasty: JSES. https://doi.org/10.1016/j.sart.2026.151556
- Lawand, J. J., Tansey, P. J., Ghali, A., et al. (2025). GLP-1 receptor agonist use and perioperative complications after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. https://www.sciencedirect.com/science/article/abs/pii/S1058274624007985
- National outcomes study on TSA and GLP-1 therapy. https://pubmed.ncbi.nlm.nih.gov/39322005/
- Magruder, M. L., et al. (2024). Semaglutide use prior to total hip arthroplasty. Journal of Arthroplasty. https://pubmed.ncbi.nlm.nih.gov/36990422/
- Magruder, M. L., et al. (2023). Does semaglutide use decrease complications following total knee arthroplasty? Journal of Arthroplasty. https://pubmed.ncbi.nlm.nih.gov/37588400/
- Obese shoulder arthroplasty database study. https://www.sciencedirect.com/science/article/abs/pii/S1045452725000689
- van Zuylen, M. L., et al. (2024). Perioperative management of long-acting GLP-1 receptor agonists. British Journal of Anaesthesia. https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-024-00439-y
