(1241) Impact of Preoperative Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes Following Sinus Surgery

Introduction: There is an increase in utilization of Glucagon-Like Peptide 1 (GLP-1) receptor agonists for weight loss in management of obesity. The objective of this study is to evaluate the impact of preoperative GLP-1 receptor agonist use on postoperative outcomes and complications following sinus surgery for chronic rhinosinusitis with nasal polyposis (CRSwNP).

Methods: This is a multicenter, retrospective cohort study utilizing de-identified patient data from the TriNetX database in the United States from 44 participating healthcare organizations. All patients were adults aged 18 years or older who have a history of CRSwNP, obesity (BMI ≥30 kg/m2), sinus surgery, and usage of GLP-1 receptor agonists before surgery. Propensity score matching was utilized to control for history of asthma and allergic rhinitis. Outcomes and complications evaluated included epistaxis, the need to control epistaxis, biologic therapy usage, cerebrospinal fluid (CSF) leak and the need for repair, anosmia, injury to the orbit, and revision sinus surgery. Outcomes were reported as relative risks (RR) with 95% confidence intervals (95% CI) up to 2 years after surgery.

Results: Patients with a history of GLP-1 receptor agonist usage within 3 months, 6 months, and 1 year before surgery had a significantly higher rate of epistaxis compared to those with no GLP-1 receptor agonist usage (RR: 1.85[1.01-3.48]; 3.35[1.73-6.49]; 2.06[1.22-3.46]). GLP-1 receptor agonist usage within 1 year was associated with a higher rate of needing to control epistaxis (RR: 2.21[1.06-4.62]). There was an increased need for biologic therapy for patients with a history of GLP-1 receptor agonist usage within 3 months before surgery (RR: 2.13[1.15-3.93]). There was no increased risk of CSF leak, anosmia, injury to the orbit, and revision sinus surgery.

Conclusions: History of GLP-1 receptor agonist usage may be associated with increased risk of epistaxis following sinus surgery. Injury to adjacent structures, CSF leak, anosmia, and revision sinus surgery do not appear to be increased.