Effects of Semaglutide and Liraglutide on Outcomes After Single-Level Lumbar Fusion Surgery in Obese Patients – A Database Analysis

Introduction: Glucagon-like peptide-1 (GLP-1) agonists, such as Semaglutide and Liraglutide, are becoming increasingly popular weight loss treatments in the US. The number of obese candidates for lumbar fusion is expected to rise. This study aimed to compare postoperative outcomes after single-level lumbar fusion surgery in obese patients using Liraglutide and Semaglutide.

Methods: PearlDiver Mariner Database was used for this retrospective cohort study. Obese patients undergoing index single-level lumbar fusion surgery who started using Liraglutide or Semaglutide were identified using CPT codes and compared to obese patients not using these drugs. Multivariable regressions were used to identify complications based on weight loss drugs, adjusting for BMI at the time of surgery, mean family income, age, sex, region, ECI, insurance plan, and diabetes status.

Results: This study reports on 23,654 patients, with 3,522 (14.9%) in Liraglutide, 861 (3.6%) in Semaglutide, and 19,271 (81.5%) in No-Drug cohort. Liraglutide had decreased odds of deep vein thrombosis (adjusted Odds Ratio (aOR) Liraglutide 90 days (L90) = 0.79, Liraglutide 365 days (L365) = 0.79) and readmission rates (aOR L90 = 0.84, L365 = 0.85), while increased odds of deep wound infection (aOR L90 = 1.39, L365 = 1.39), sepsis (aOR L90 = 1.15, L365 = 1.15), and acute kidney injury (aOR L90 = 1.36, L365 = 1.37). Meanwhile, Semaglutide decreased the odds of hematoma (aOR Semaglutide 90 days (S90) = 0.43, Semaglutide 365 days (S365) = 0.44), sepsis at 90 days (aOR S90 = 0.73, S365 = 0.74), stroke (aOR S90 = 0.64, S365 = 0.65), pneumonia (aOR S90 = 0.56, S365 = 0.56), urinary tract infection (aOR S90 = 0.73, S365 = 0.75), and emergency department visits (aOR S90 = 0.65, S365 = 0.67), while it increased the odds for deep wound infection (aOR S90 = 2.08, S365 = 2.11). In total costs, 365- and 720-day total costs were higher in both the Liraglutide and Semaglutide cohorts. Generally, the odds of complications increased during the first year after starting the medicines.

Conclusion : Semaglutide is associated with more beneficial outcomes, while Liraglutide had mixed outcomes. The adverse outcomes were more prominent with surgery within the first year of starting the medicine.