No Difference in Short-Term Surgical Outcomes from Semaglutide Treatment for T2DM after 3-Level-or-Greater Posterior Lumbar Spine Decompression and Fusion: A Propensity Score-Matched Analysis

Introduction: Semaglutide, a GLP-1 receptor agonist, is gaining popularity as a weekly injectable medication for the treatment of T2DM and obesity. Existing research indicates that higher levels of HbA1c are linked to fewer positive results after spine surgery. Nevertheless, there is a scarcity of publications evaluating the influence of semaglutide therapy on surgical complications. This study seeks to evaluate the impact of semaglutide treatment for Type 2 Diabetes Mellitus (T2DM) on the composite risk of short-term ( < 6 months) postoperative complications including surgical site infection, wound complications, and reoperation in patients undergoing 3-level-or-greater posterior lumbar spine decompression and fusion in the United States.

Methods: The PearlDiver Database was queried from January 2010 to December 2021 for patients with a primary diagnosis of T2DM within 2 years prior to 3 or more levels posterior lumbar spine decompression and fusion. Patients with semaglutide treatment within 6 months before index surgery were propensity score-matched to patients without the treatment, i.e. control in a 1:1 ratio, employing age, gender, and Charlson comorbidity index (CCI) as matching covariates. A multivariate regression model was used, adjusting for confounding variables to investigate the impact of semaglutide treatment on postoperative surgical complications rate.

Results: The propensity score-matched cohort included 296 patients (semaglutide cohort: 148, control cohort: 148). There were no statistically significant differences between cohorts in the composite measure of postoperative surgical complications following index surgery (OR 1.46, 95% CI 0.80-2.67, p = 0.285). Similarly, both 30-day (OR 1.00, 95% CI 0.48-2.08, p = 1.000) and 90-day readmission rate (OR 1.26, 95% CI 0.65-2.46, p = 0.610) were similar between both cohorts.

Conclusion : This study suggests that in patients with T2DM, semaglutide treatment is not associated with higher rates of adverse events after 3 or more levels posterior lumbar spine decompression and fusion. The effect of semaglutide use on long-term outcomes remains unknown.