Risk of Postoperative Complications in Patients Who Underwent Transsphenoidal Pituitary Surgery Treated with Glucagon-Like Peptide Agonists (TRINETX)

Background: Since FDA approval of semaglutides for weight loss in 2021, glucagon-like peptide agonists (GLP-1), such as Wegovy and Ozempic are more commonly used. Given the more popular use of these drugs, our study aimed to examine the impact of GLP-1 agonists on postoperative outcomes and 30-day readmission after transsphenoidal pituitary surgery (TSS).

Materials and Methods: Utilizing TriNetX, which contains over 166 million patient profiles in the United States (US), we created a cohort of patients who underwent TSS (CT: 62165) on GLP-1 agonists (ATC: A10BJ) as well as a cohort of patients who underwent TSS without GLP-1 agonist use from the years 2006 to 2023. We obtained demographic data for each cohort. A t-test was used to determine if a statistically significant difference existed between the proportion of females between the two cohorts. Logistic regression models were utilized to calculate odds ratio (OR) of specific postsurgical outcomes to determine the effects of GLP-1 agonists on TSS outcomes. These included 30 day re-admission, emergency department visits, acute kidney injury, and meningitis/encephalitis. Timeframe of outcomes were queried to be from day of surgery to any extended time thereafter, while re-admission was queried to be within 30 days after surgery.

Results: We identified 6,669 patients who underwent TSS not on a GLP-1 agonist and 658 patients who underwent TSS while on a GLP-1 agonist. For the non-GLP-1 cohort, mean age was 58, 48.6% were female, 63.3% were white, 16.2% were African American, and 4.4% were Asian ([Table 1]). For the GLP-1 cohort, mean age was 54, 65.2% were female, 64.3% were white, 16.2% were African American, and 3.9% were Asian ([Table 1]). The ratio of females between the two cohorts was statically significant (p < 0.0001). There was increased odds of postoperative inpatient admission within 30 days of surgery (OR 7.5; CI 95%: 3.38, 16.60) and acute kidney injury (AKI) (OR 1.44, CI 95%: 1.001, 2.06) when patients underwent TSS while using GLP-1 agonist. Other postoperative outcomes such as emergency department visits, CSF leak, deep vein thrombosis, postoperative infection, meningitis/encephalitis, respiratory failure, thyrotoxicosis, and delirium did not demonstrate a statistically significant increased risk between the two cohorts ([Table 2]).

Conclusion: In summary, other than the GLP-1 agonist use group having a significantly higher ratio of females, both cohorts demonstrated similar demographics in which the majority of patients were female, white, and displayed a mean age in the 50s. Patients who underwent TSS while using a GLP-1 agonist did demonstrate increased odds of postoperative 30-day inpatient admission and AKI. Further studies may utilize a larger sample size or include propensity score matching to help reduce the effects of confounding variables.

Publication History

Article published online:
07 February 2025