As Few as Three Months of Preoperative Semaglutide Exposure Prior to Total Knee Arthroplasty Is Associated With Reduced Postoperative Adverse Events in Patients Who Have Type II Diabetes.

BACKGROUND: Semaglutide, a glucagon-like peptide-1 receptor agonist, has been increasingly used for the management of type II diabetes mellitus (T2DM). Although recent literature suggests semaglutide may reduce postoperative total knee arthroplasty (TKA) complications, to our knowledge, the minimum duration of semaglutide exposure associated with superior outcomes has never been studied. METHODS: A retrospective cohort of patients with T2DM was identified from a national database and stratified into one of five mutually exclusive groups of semaglutide exposure before TKA: six to 12 months, three to six months, two to three months, one to two months, or less than one month. Each cohort was individually matched 1:4 with non-semaglutide T2DM TKA controls. The occurrence of 90-day severe adverse events including surgical site infection, sepsis, venous thromboembolism, cardiac events, pancreatitis, and minor adverse events (MAEs) including wound dehiscence, hematoma, transfusion, acute kidney injury, pneumonia, and urinary tract infection, was compared using multivariable logistic regression. RESULTS: After matching, patient cohorts with preoperative semaglutide exposure for six to 12 months, three to six months, two to three months, one to two months, and less than one month included 745, 451, 210, 113, and 91, respectively. Patients initiating semaglutide less than one month before TKA revealed lower odds of MAE (odds ratio 0.16, P < 0.001), with consistent reduction in MAE across all increased exposure durations (P < 0.001 for all). Reduced odds of severe adverse events were significant after a minimum of two to three months of preoperative exposure (odds ratio 0.25, P < 0.001). CONCLUSIONS: A 3-month period of preoperative semaglutide exposure before TKA appears to be sufficient to reduce both minor and severe postoperative adverse events. Although these observational findings cannot establish causation, they have major clinical implications and lay the foundation for prospective analysis aimed at optimizing preoperative care pathways.