---
title: "SGLT2 Inhibitors and 90-Day Myocardial Infarction Risk After Total Shoulder Arthroplasty"
id: "pubmed-42012366"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42012366"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42012366/"
doi: "10.5435/JAAOS-D-25-01211"
published_at: "2026-08-15T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# SGLT2 Inhibitors and 90-Day Myocardial Infarction Risk After Total Shoulder Arthroplasty
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42012366
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42012366/)
- **DOI:** [10.5435/JAAOS-D-25-01211](https://doi.org/10.5435%2FJAAOS-D-25-01211)
- **Published At:** 2026-08-15T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study evaluated perioperative **SGLT2i** exposure and postoperative complication rates in diabetic patients undergoing **total shoulder arthroplasty (TSA)** using the TriNetX database. - Patients were stratified by SGLT2i prescription status and balanced with 1:1 propensity score matching to adjust for demographics and comorbidities. - After matching, each cohort included 2,360 patients. - Primary outcomes assessed were 90-day medical and surgical complications and 2-year implant-related complications. - The SGLT2i cohort had a higher 90-day incidence of **myocardial infarction** compared with controls (2.03% vs 0.89%, P = 0.001). - No significant between-group differences were observed in 90-day rates of ketoacidosis, deep vein thrombosis, pulmonary embolism, stroke, pneumonia, acute kidney injury, transfusion, wound disruption, sepsis, or hospital readmission. - At 2 years, there was no increased risk of implant-related complications in patients prescribed SGLT2i. - Authors conclude SGLT2i use was associated with increased early postoperative myocardial infarction risk after TSA but appeared safe with respect to implant outcomes; further research was recommended. - Level of evidence stated as III. - Study details: retrospective cohort analysis using TriNetX, propensity score matching; exact matching variables and other methodological specifics were described in the source but not exhaustively listed in the abstract.
## Clinical Analysis & Structured Key Points
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Epub 2026 Apr 21. # SGLT-2 Inhibitor Effects on Medical and Surgical Complication Rates After Total Shoulder Arthroplasty: A Propensity Matched Cohort Study [Tarek Haj Shehadeh](https://pubmed.ncbi.nlm.nih.gov/?term=Haj+Shehadeh+T&cauthor_id=42012366)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42012366/#full-view-affiliation-1 "From the Department of Orthopedic Surgery, Cleveland Clinic Foundation, Weston, FL \(Haj Shehadeh\), and the Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA \(Boufadel, Abboud\)."), [Peter Boufadel](https://pubmed.ncbi.nlm.nih.gov/?term=Boufadel+P&cauthor_id=42012366), [Joseph A Abboud](https://pubmed.ncbi.nlm.nih.gov/?term=Abboud+JA&cauthor_id=42012366) Affiliations Expand ### Affiliation * 1 From the Department of Orthopedic Surgery, Cleveland Clinic Foundation, Weston, FL (Haj Shehadeh), and the Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA (Boufadel, Abboud). * PMID: **42012366** * DOI: [ 10.5435/JAAOS-D-25-01211 ](https://doi.org/10.5435/jaaos-d-25-01211) Item in Clipboard # SGLT-2 Inhibitor Effects on Medical and Surgical Complication Rates After Total Shoulder Arthroplasty: A Propensity Matched Cohort Study Tarek Haj Shehadeh et al. J Am Acad Orthop Surg. 2026. Show details Display options Display options Format Abstract PubMed PMID J Am Acad Orthop Surg Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Am+Acad+Orthop+Surg%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Am+Acad+Orthop+Surg%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) . 2026 Aug 15;34(16):e2255-e2260. doi: 10.5435/JAAOS-D-25-01211. Epub 2026 Apr 21. ### Authors [Tarek Haj Shehadeh](https://pubmed.ncbi.nlm.nih.gov/?term=Haj+Shehadeh+T&cauthor_id=42012366)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42012366/#short-view-affiliation-1 "From the Department of Orthopedic Surgery, Cleveland Clinic Foundation, Weston, FL \(Haj Shehadeh\), and the Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA \(Boufadel, Abboud\)."), [Peter Boufadel](https://pubmed.ncbi.nlm.nih.gov/?term=Boufadel+P&cauthor_id=42012366), [Joseph A Abboud](https://pubmed.ncbi.nlm.nih.gov/?term=Abboud+JA&cauthor_id=42012366) ### Affiliation * 1 From the Department of Orthopedic Surgery, Cleveland Clinic Foundation, Weston, FL (Haj Shehadeh), and the Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA (Boufadel, Abboud). * PMID: **42012366** * DOI: [ 10.5435/JAAOS-D-25-01211 ](https://doi.org/10.5435/jaaos-d-25-01211) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Introduction:** Total shoulder arthroplasty (TSA) is being performed with increasing frequency and is projected to rise further in the coming years. Although generally successful, the procedure carries inherent risks. Diabetes is a well-established risk factor for postoperative complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective antidiabetic agents that are widely used; however, their perioperative safety in the setting of TSA has not yet been evaluated. The objective of this study was to assess the effect of perioperative SGLT2i use on 90-day medical complications and 2-year implant-related complications in diabetic patients undergoing TSA. **Methods:** The TriNetX database was queried to identify diabetic patients who underwent TSA. Patients were stratified according to SGLT2i prescription status, and 1:1 propensity score matching was done to adjust for relevant demographic and medical comorbidities. Outcomes of interest included 90-day medical and surgical complications and 2-year implant-related complications. **Results:** After propensity score matching, each cohort included 2,360 patients. The SGLT2i cohort demonstrated a significantly higher 90-day risk of myocardial infarction compared with control subjects (2.03% vs 0.89%, P = 0.001). No significant differences were observed between groups in the 90-day risk of ketoacidosis, deep vein thrombosis, pulmonary embolism, stroke, pneumonia, acute kidney injury, transfusion, wound disruption, sepsis, or hospital readmission. Similarly, there was no increased risk of implant-related complications at 2 years postoperatively in the SGLT2i cohort. **Discussion:** SGLT2i use was associated with an increased 90-day risk of myocardial infarction after TSA but appeared safe regarding implant-related outcomes. Additional research is warranted to clarify these associations; however, these findings may aid in preoperative counseling and optimization of surgical outcomes. **Level of evidence:** III. Copyright © 2026 by the American Academy of Orthopaedic Surgeons. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Elevated risk of medical and implant-related complications in patients with hypothyroidism after total shoulder arthroplasty: a 1:1 propensity matched cohort analysis. ](https://pubmed.ncbi.nlm.nih.gov/39701443/) Lawand JJ, Ghali A, Casanova C, Papakostas E, Al Khelaifi K, Zikria B, Khan AZ, Abboud JA.Lawand JJ, et al.J Shoulder Elbow Surg. 2025 Jul;34(7):e497-e504. doi: 10.1016/j.jse.2024.10.015. Epub 2024 Dec 17.J Shoulder Elbow Surg. 2025.PMID: 39701443 * [ Preoperative malnutrition is associated with increased risk of 90-day major medical complications and increased 2-year revision rates following total shoulder arthroplasty. ](https://pubmed.ncbi.nlm.nih.gov/40250824/) Lawand JJ, Rizk AA, Sogbein OA, Granruth C, Ghali A, Hill BW, Khan AZ, Horneff JG, Abboud JA.Lawand JJ, et al.J Shoulder Elbow Surg. 2025 Dec;34(12):e1151-e1158. doi: 10.1016/j.jse.2025.03.005. Epub 2025 Apr 16.J Shoulder Elbow Surg. 2025.PMID: 40250824 * [ Does use of glucagon-like peptide-1 agonists increase perioperative complications in patients undergoing shoulder arthroplasty? ](https://pubmed.ncbi.nlm.nih.gov/39322005/) Elsabbagh Z, Haft M, Murali S, Best M, McFarland EG, Srikumaran U.Elsabbagh Z, et al.J Shoulder Elbow Surg. 2025 Apr;34(4):997-1006. doi: 10.1016/j.jse.2024.07.045. Epub 2024 Sep 23.J Shoulder Elbow Surg. 2025.PMID: 39322005 * [ Preoperative testosterone replacement therapy is associated with increased rates of periprosthetic joint infection, acute kidney injury, and emergency department utilization after total shoulder arthroplasty: a propensity-score matched analysis. ](https://pubmed.ncbi.nlm.nih.gov/40902712/) White AE, Omurzakov A, Omurzakov AM, Athanasian CE, Brusalis CM, Kew ME, Fu MC, Gulotta LV, Taylor SA.White AE, et al.J Shoulder Elbow Surg. 2026 Mar;35(3):689-696. doi: 10.1016/j.jse.2025.07.022. Epub 2025 Sep 1.J Shoulder Elbow Surg. 2026.PMID: 40902712 * [ Glucagon-like peptide-1 receptor agonist use and perioperative outcomes after anterior cervical discectomy and fusion: a propensity-matched cohort study. ](https://pubmed.ncbi.nlm.nih.gov/41482188/) Heo KY, Barchick SR, Sowa AM, Chao M, Rajan PV, Goh BC, Yoon ST.Heo KY, et al.Spine J. 2026 May;26(5):882-892. doi: 10.1016/j.spinee.2025.12.019. Epub 2025 Dec 31.Spine J. 2026.PMID: 41482188 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42012366) ## References 1. 1. Cecora AJ, Ragland D, Vallurupalli N, et al.: Projections of utilization of primary and revision shoulder arthroplasty in the United States in the next 40 years. JSES Int 2025;9:472-476. 2. 1. Ma GC, Bradley KE, Jansson H, Feeley BT, Zhang AL, Ma CB: Surgical complications after reverse total shoulder arthroplasty and total shoulder arthroplasty in the United States. J Am Acad Orthop Surg Glob Res Rev 2021;5:e21.00146. 3. 1. Ponce BA, Menendez ME, Oladeji LO, Soldado F: Diabetes as a risk factor for poorer early postoperative outcomes after shoulder arthroplasty. J Shoulder Elbow Surg 2014;23:671-678. 4. 1. Duey AH, White CA, Levy KH, et al.: Diabetes increases risk for readmission and infection after shoulder arthroplasty: A national readmissions study of 113,713 patients. J Orthop 2023;38:25-29. 5. 1. Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S: Diabetes 2030: Insights from yesterday, today, and future trends. Popul Health Manag 2017;20:6-12. Show all 20 references ## MeSH terms * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Arthroplasty, Replacement, Shoulder* / adverse effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Arthroplasty%2C+Replacement%2C+Shoulder%2Fadverse+effects%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Arthroplasty%2C+Replacement%2C+Shoulder) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Cohort Studies Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cohort+Studies%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Cohort+Studies) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Diabetes Mellitus, Type 2* / complications Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Diabetes+Mellitus%2C+Type+2%2Fcomplications%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Diabetes+Mellitus%2C+Type+2) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Diabetes Mellitus, Type 2* / drug therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Diabetes+Mellitus%2C+Type+2%2Fdrug+therapy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Diabetes+Mellitus%2C+Type+2) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Female Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Female%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Female) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Male Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Male%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Male) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Middle Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Middle+Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Middle+Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Myocardial Infarction / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Myocardial+Infarction%2Fepidemiology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Myocardial+Infarction) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Myocardial Infarction / etiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Myocardial+Infarction%2Fetiology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Myocardial+Infarction) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Postoperative Complications* / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Postoperative+Complications%2Fepidemiology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Postoperative+Complications) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Postoperative Complications* / etiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Postoperative+Complications%2Fetiology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Postoperative+Complications) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Propensity Score Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Propensity+Score%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Propensity+Score) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Retrospective Studies Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Retrospective+Studies%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Retrospective+Studies) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42012366/) * Risk Factors Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Risk+Factors%22%5BM
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