Pre-Operative GLP-1 Agonist Use May Decrease Risk of Post-Operative Pseudarthrosis Following Lumbar Spinal Fusion

Introduction: Pseudarthrosis is a relatively common complication following spinal fusion and can lead to significant pain, functional impairment, and the need for revision surgery. Risk factors for the development of pseudarthrosis include advanced age, obesity, smoking, and decreased bone quality. Given the recent increases in GLP-1 use in the United States, we investigated the impact of pre-operative GLP-1 agonist use on post-operative pseudarthrosis risk following lumbar spinal fusion.

Methods: Using ICD-10 coding, we used the TriNetX database to identify patients undergoing lumbar spinal fusion with a diagnosis of overweight/obesity and/or a documented BMI ≥ 30 who subsequently developed pseudarthrosis at any point following surgery. We propensity matched this cohort based on age, sex, race/ethnicity, and medical comorbidities to patients prescribed a GLP-1 agonist up to 1 year pre-operatively. Smokers were excluded from this study. The primary endpoint was documented post-operative development of pseudarthrosis.

Results: A total of 2,729 patients were included in each cohort. The mean age was 61.7 years and most patients were female (57%). Patients prescribed a GLP-1 agonist up to 1 year pre-operatively experienced decreased risk (RR: 0.665; 95%-CI: 0.541-0.817) and odds (OR: 0.647; 95%-CI: 0.519-0.806) of developing postoperative pseudarthrosis.

Conclusion : Pre-operative use of GLP-1 agonists may reduce the risk of post-operative pseudarthrosis in patients undergoing lumbar spinal fusion. These findings may help guide pre-operative management of patients with obesity preparing for lumbar spinal fusion surgery.