GLP-1 receptor agonist therapy is not associated with adverse events following shoulder surgery: a systematic review and meta-analysis

Glucagon-like peptide-1 agonists (GLP-1s) are increasingly prescribed for type 2 diabetes mellitus (T2DM) and obesity, with over 12% of the United States population reported to being using this medication. While GLP-1s have been associated with reduced complication rates in total hip and knee arthroplasty populations, their association with outcomes after shoulder surgery remains unclear. The purpose of the current study was to perform a systematic review and meta-analysis of studies comparing adverse events between GLP-1 users and non-users following shoulder surgery. A PRISMA-compliant literature search of PubMed, Embase, and Scopus was performed in August 2025. Comparative studies (Level of Evidence I-III) assessing postoperative adverse events in GLP-1 and non-GLP-1 users undergoing total shoulder arthroplasty (TSA) or shoulder arthroscopic procedures were included. Data pertaining to 90-day and 2-year complication rates were extracted. Random effects meta-analyses were conducted independently for TSA studies and pooled odds ratios with confidence estimates were quantified. Outcomes of studies examining arthroscopic procedures were described narratively given limited data. Six studies encompassing outcomes of 43,415 patients were included. Four (66.7%) studies evaluated TSA, while one evaluated arthroscopic RCR and one manipulation under anesthesia/capsular release for adhesive capsulitis (AC). The overall pooled 90-day complication rate following TSA was 18.1% for GLP-1 users and 15.9% for non-users (OR = 0.86, 95% CI: 0.36-2.07, P = .74). The overall pooled 2-year complication rate following TSA was 3.8% in the GLP-1 group and 3.7% in the non-GLP-1 group (OR = 1.24, 95% CI: 0.73-2.00, P = .42). The RCR and AC studies reported significantly lower 90-day complication rates for GLP-1 users (11.0% vs. 27.4%) and (2.5% vs. 4.8%), respectively. A lower re-tear rate was observed in GLP-1 users compared with non-users by 2-years postoperatively (12.5% vs. 18.3%). GLP-1 agonist use is not significantly associated with 90-day or 2-year adverse events following TSA. Based on this data, GLP-1 agonist use should not be a contraindication for proceeding with TSA. Lower complication rates were observed in both studies concerning arthroscopic intervention for non-arthritic shoulder conditions.