Postoperative Complication Risk in Idiopathic Intracranial Hypertension Patients Treated with Glucagon-Like Peptide-1 Receptor Agonists

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) such as semaglutide, exenatide, and liraglutide have gained popularity in recent years and are effective weight loss medications. GLP-1-RAs have shown promise as an intervention treating idiopathic intracranial hypertension (IIH) by increasing weight loss and reducing IIH symptoms. In refractory IIH, cerebrospinal fluid (CSF) diversion with ventriculoperitoneal shunt (VPS) is a common treatment. GLP-1-RAs have been associated with increased complication rates in other surgical literature though rates in IIH patients undergoing VPS have not been investigated.

Objective: This article aims to determine the risk of common postoperative complications in IIH patients on GLP-1-RAs undergoing VPS.

Methods: TriNetX, a multi-institutional database, was queried for adult patients with IIH undergoing VPS placement from 2014 to 2023. Cohorts were based on documented prescription of GLP-1-RAs including semaglutide, liraglutide, dulaglutide, exenatide, lixisenatide, or tirzepatide. Patients on GLP-1-RAs were compared against those not prescribed GLP-1-RAs. Logistic regression models were used to assess odds ratios (ORs) for early postoperative complications within 30 days.

Results: A total of 3,713 IIH patients without GLP-1-RAs and 208 patients with GLP-1-RAs underwent VPS. Most patients were female in both non-GLP-1-RA and GLP-1-RA cohorts (63.6 and 83.2%, respectively) and the mean age at surgery was 35.5 years and 44.4 years ([Table 1]). Complication rates differed slightly between cohorts ([Fig. 1]). Patients undergoing VPS on GLP-1-RAs had increased risk of deep vein thrombosis (OR: 2.35; 95% CI: 1.20, 4.62), pneumonia (OR: 2.11; 95% CI: 1.08, 4.11), and postoperative infection (OR: 3.13; 95% CI: 1.58, 6.21; [Table 2]). Other outcomes did not demonstrate a significant difference.

Table 1 Clinical and demographic information

No GLP-1-RA	n = 3713	GLP-1-RA	n = 208
Age (mean, SD)	35.5 (20)	Age (mean, SD)	44.4 (12.5)
Sex (female)	63.64%	Sex (female)	83.15%
White	63.02%	White	63.15%
Black	20.58%	Black	24.21%
Asian	2.28%	Asian	5.26%
Other	14.29%	Other	13.68%

Table 2 Postoperative complication risk

Risk with GLP-1-RA	OR (95% CI)
30-day readmission	0.94 (0.65, 1.37)
CSF leak	1.24 (0.69, 2.21)
Deep vein thrombosis	2.35 (1.20, 4.62)
Urinary tract infection	1.13 (0.59, 2.17)
Pneumonia	2.11 (1.08, 4.11)
Postoperative infection	3.13 (1.58, 6.21)
Meningitis/Encephalitis	1.86 (0.96, 3.63)
Respiratory failure	0.87 (0.46, 1.67)
Acute kidney injury	1.57 (0.81, 3.04)

Conclusion: GLP-1-RAs are increasingly prescribed for weight loss, including in patients with IIH. GLP-1-RAs may increase the risk of early postoperative adverse events such as deep vein thrombosis, pneumonia, and postoperative infection within 30 days post-op. Larger studies and prospective research should be completed to further investigate this association.

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Artikel online veröffentlicht:
07. Februar 2025