(623) GLP-1 Agonists and Free Flap Outcomes in Head & Neck Surgery

Introduction: GLP-1 receptor agonists are increasingly prescribed for glycemic control and weight loss. These agents are associated with delayed gastric emptying, nausea, emesis, and perioperative aspiration risk, raising concerns for stress on upper aerodigestive tract reconstructions. Conversely, preclinical studies and limited clinical data suggest potential benefits for wound healing and flap perfusion via anti-inflammatory mechanisms. Data on GLP-1-related outcomes specific to head and neck cancer (HNC) oncologic and reconstructive procedures are limited.

Methods: A retrospective cohort study was performed using the Epic Cosmos database (January 2018 - December 2025), comprising over 300 million patient records across 1,883 hospitals. HNC patients with diabetes treated for >1 year with either GLP-1 receptor agonists or non-GLP agents were included. Outcomes included OR takeback, healing complications (flap failure, delayed healing, dehiscence, or fistula), infection, hematoma, aspiration, length of stay (LOS), and completion of adjuvant treatment. Statistical analysis was performed with chi-square testing.

Results: 275 GLP-1 patients and 1,196 controls were identified. GLP-1 patients were more often female (38% vs 30%, p = 0.01), White (83% vs 77%, p = 0.03), and Hispanic (8% vs 4%, p = 0.02). Age and HbA1c distribution varied significantly; median age was lower in the GLP group (65 vs 70 years), while HbA1c was higher (7.1% vs 6.6%). Laryngeal cancer was less common in GLP-1 patients (11% vs 16%, p = 0.03); rates at other subsites were similar. LOS and rates of OR takeback, healing complications, infection, hematoma, aspiration, and completion of adjuvant treatment did not differ significantly between groups.

Conclusions: GLP-1 receptor agonist use was not associated with increased perioperative complications following HNC reconstruction. Despite uncertainty in perioperative GLP-1 management, these findings suggest no increased surgical risk or requirement to modify use in this population. Further investigation may clarify whether specific patient subsets ultimately derive benefit from GLP-1 use.