Impact of GLP-1 Receptor Agonists on Postoperative Outcomes of Lumbar Spine Surgery

Introduction: Patients undergoing spinal procedures increasingly use glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally for type 2 diabetes and now popular for weight loss. The impact of GLP-1 RAs on spinal fusion outcomes is unknown. This study examines their effect on medical and mechanical complications within 90 days post-lumbar spine surgery.

Methods: This retrospective cohort study used medical records from TriNetX, a national de-identified database, to examine diabetic patients undergoing lumbar spine procedures. Patients who received GLP-1 RAs within six months preoperatively were compared to a propensity-matched control group. Propensity score matching (1:1) controlled for demographic factors and comorbidities, including type I and II diabetes, metformin use, and BMI. The study analyzed 90-day medical and 1-year implant complications using Chi-squared exact tests and univariate regression in a propensity-matched cohort.

Results: The GLP-1 RA cohort and control group included 1,110 and 151,440 patients, respectively. Of these, 1,090 patients were propensity matched 1:1 in each cohort. Within 90 days postoperatively, the GLP-1 RA group had higher rates of all-cause anemia (9.4% vs. 7.0%, p=0.016), renal failure (4.4% vs. 2.9%, p=0.028), opioid use (94% vs. 89%, p< 0.001), emergency room visits (16% vs. 13%, p=0.013), and wound complications (0.5% vs. 0.2%, p< 0.001). Other complications, such as infections, myocardial infarction, pulmonary embolism, deep vein thrombosis, hypoglycemic events, stroke, hospitalization, pneumonia, and transfusion, were similar between groups. One year postoperatively, pseudoarthrosis was less frequent in the GLP-1 RA group (12% vs. 16%, p=0.002). There were no significant differences in hospitalization, adjacent segment disease, mechanical loosening, or post-laminectomy syndrome.

Conclusion : This study found that the risk of complications in patients receiving GLP-1 RAs before lumbar spine surgery is comparable to control patients, suggesting GLP-1 RAs do not increase adverse outcomes and should not exclude patients from surgery.