GLP-1s in Foot and Ankle Surgery

A 2026 systematic review found neutral or potentially better perioperative outcomes among people using GLP-1 receptor agonists before foot and ankle surgery. The review covered 5,520 patients in three comparative studies. All three studies were retrospective, so the findings show associations rather than proof that GLP-1 treatment caused fewer complications^[1].

Omkar Anaspure and colleagues published the review online in The Journal of Foot & Ankle Surgery on 27 July 2026. They evaluated GLP-1 receptor agonist use before surgery rather than testing a new treatment protocol. The paper's indexed keywords include semaglutide, but the abstract reports results for the drug class and does not separate outcomes by individual medicine^[2].

The review found neutral or better outcomes

The authors searched PubMed, EMBASE and CINAHL from database inception through November 2025. They used narrative synthesis, meaning they described the pattern across studies instead of calculating one pooled treatment effect. Frequency-weighted means summarized the patient characteristics^[1].

Across the included studies, GLP-1 receptor agonist use was generally associated with outcomes that were either neutral or improved. The review reported lower pseudarthrosis rates after subtalar and triple arthrodesis. Pseudarthrosis means the intended bone fusion did not unite. It also reported less early hardware removal after fixation of ankle fractures^[2].

Some included studies found lower odds of medical complications such as infection and deep vein thrombosis. They also reported lower odds of myocardial infarction. Other studies found no significant differences, so the abstract does not support one consistent reduction across every complication or operation^[1].

The review does not provide event counts, effect sizes or confidence intervals for those individual outcomes in its abstract. Without those details, readers cannot tell how large each association was or how precise the estimate might be. Direction alone leaves the clinical size uncertain.

Most patients had ankle fracture fixation

The review included 5,520 patients. Their mean age was 55.09 years, with a reported standard deviation of 14.65 years. Women accounted for 65.96% of the cohort, or 3,641 people, and 76.67% had a body mass index above 30, or 4,232 people^[2].

Open reduction and internal fixation for ankle fractures accounted for 71.63% of the cohort, or 3,954 patients. In this procedure, the surgeon restores the bone position and holds it with internal hardware. The remaining patients underwent arthrodesis for degenerative disease, a procedure intended to fuse a painful joint^[1].

That case mix matters. An ankle fracture fixed with plates or screws differs from a planned fusion for degenerative disease. The abstract combines these groups when describing the review population, while its outcome examples remain tied to particular operations. It does not establish that the same association applies to every foot and ankle procedure.

Readers who want background on the medicine named in the paper's keywords can use our semaglutide research overview. Our semaglutide regulation section covers current country-level status. This surgical review evaluates the GLP-1 receptor agonist class and does not establish a semaglutide-specific surgical effect.

Retrospective evidence cannot prove protection

The authors describe the small number of studies and their retrospective design as the main limits. Retrospective studies examine care that has already occurred. Treatment groups may differ in health status, clinical follow-up or other factors that also affect surgical outcomes, even when researchers try to adjust for those differences^[2].

The abstract does not report how each study handled confounding, which GLP-1 medicines were represented or how long patients had used them. It also does not show whether medication was continued or withheld around the operation. The review cannot answer those scheduling questions.

Neutral findings need careful reading too. A result without a statistically significant difference does not prove that two groups have identical risk. The study may have had too few events to detect a difference, or the estimate may have been close to no effect. The accessible abstract does not provide enough detail to distinguish those possibilities for each outcome.

The review does not set medication instructions

This paper does not test whether a patient should continue, pause or restart a GLP-1 receptor agonist around surgery. It reports associations among patients who used the medicines before foot and ankle procedures. Turning those observations into medication instructions would go beyond the study design and the information available in the abstract.

A person's plan can depend on the operation, the reason the medicine was prescribed and the clinical team's assessment. The review offers no randomized comparison of different perioperative schedules. Patients should discuss medication decisions with the prescribing clinician and surgical team rather than changing treatment from this review alone.

What we don't yet know

Prospective research could define the medicine used, record the timing around surgery and apply the same outcome definitions across treatment groups, while randomization would offer stronger protection against baseline differences than the current retrospective evidence. Well-designed prospective observational work could also help. The current review cannot show whether any association comes from the medicine itself or from differences between the people who did and did not receive it.

The available abstract also leaves drug-specific outcomes unresolved. It does not separate semaglutide from other GLP-1 receptor agonists, compare different operations within a common model or provide long-term revision rates. For now, the review supports cautious interest in a neutral to potentially favorable perioperative profile, not a claim of surgical protection.

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