Surgery · Nov 2026
Pre-Injury Metabolic Therapy and Clinical Outcomes After Rib Fractures
By Henriquez MJ, Boukind A, Sanchez FC et al.
Background GLP-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) are widely used metabolic therapies whose association with trauma outcomes is poorly characterized. Given growing GLP-1RA use, we evaluated whether pre-injury GLP-1RA use was associated with outcomes after multiple rib fractures and whether any association was specific to GLP-1RAs. Methods In a retrospective cohort study using the TriNetX U.S. Collaborative Network (January 2015 to August 2026), adults with multiple rib fractures and a pre-injury GLP-1RA prescription were matched 1:1 to controls on 38 baseline characteristics. Primary outcomes were 90-day mortality and critical-care utilization. Specificity was tested by comparing GLP-1RA with SGLT2i users and SGLT2i users with controls. Results Among 7,131 matched pairs, GLP-1RA use was associated with lower 90-day mortality (4.0% vs 6.5%; OR 0.60; 95% CI 0.52–0.70), ICU admission (OR 0.78), intubation (OR 0.55), and respiratory failure (OR 0.77); other complications did not differ. Associations were preserved at 30 days. GLP-1RA and SGLT2i users did not differ significantly in mortality (OR 0.86; 95% CI 0.73–1.02), and SGLT2i users had lower mortality (OR 0.76; 95% CI 0.70–0.84), ICU admission (OR 0.83), and intubation (OR 0.81) than controls. Conclusions Pre-injury metabolic therapy was associated with lower mortality and critical-care utilization after rib fractures, and these outcomes did not differ significantly between classes. Because prescription records cannot confirm medication use and healthcare engagement cannot be fully measured, these are associations, not evidence of a drug effect; prospective studies with confirmed exposure are warranted.