Association of Glucagon-like Peptide-1 Receptor Agonist Use with Complications Following Thoracic and/or Lumbar Spinal Fusion for Degenerative Spine Disease

📖 Top 20% JournalSep 4, 2025Spine

Links Between Using GLP-1 Receptor Agonists and Complications After Mid-Back and Lower-Back Spinal Fusion Surgery for Spine Degeneration

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Abstract

Among 291,677 patients, 19,232 GLP-1 RA users experienced significantly reduced 90-day medical complications following spinal fusion.

Ninety-day medical complications, including infection and pneumonia, were significantly lower in GLP-1 RA users compared to controls across BMI categories ≥25.
In the 2-year follow-up, surgical complications were reduced in GLP-1 RA users with a BMI of 35-39.9, particularly for revisions related to pseudarthrosis and mechanical failure.
At 10 years, GLP-1 RA use was associated with a significantly lower risk of surgical revision in patients with a BMI of 25.0-29.9.
The risk of revision due to pseudarthrosis decreased in patients with BMI 35.0-39.9 and ≥40.0, while mechanical failure revisions were also reduced in both these groups.

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STUDY DESIGN: Retrospective Cohort.

SUMMARY OF BACKGROUND DATA: Spinal fusions are common interventions for degenerative spine disease (DSD), with increasing utilization in obese and metabolic syndrome populations. Glucagon-like peptide-1 (GLP-1) receptor agonists (RA), widely adopted for diabetes and weight management, may offer systemic benefits that exert a parallel influence on surgical outcomes.

OBJECTIVE: We aimed to evaluate whether preoperative GLP-1 RA use influences 90-day medical and 2- and 10-year surgical complications following thoracic and/or lumbar spinal fusion for DSD, stratified by BMI.

METHODS: Using a national claims database (2010-2023), we identified patients undergoing thoracic and/or lumbar spinal fusion for degenerative conditions. GLP-1 RA users within 6 months pre-op were 4:1 matched to controls by age, sex, and CCI across six BMI strata. Outcomes included 90-day medical and 2- and 10-year surgical complications (e.g., revisions for infection, pseudoarthrosis, and mechanical failure). Chi-square, t-tests, and Cox models were used for statistical analysis.

RESULTS: Among 291,677 patients, 19,232 GLP-1 RA users were matched to 76,778 controls. Ninety-day medical complications-such as infection, pneumonia, thromboembolism, sepsis, stroke, and UTI-were significantly reduced in GLP-1 RA users across BMI categories ≥25. Two-year surgical complications were lower among GLP-1 RA users in BMI 35-39.9 (1.1% vs. 1.6%, P=0.007 for pseudarthrosis-related revision; 0.8% vs. 1.2%, P=0.038 for mechanical failure) and ≥40 groups. At 10 years, GLP-1 RA use was associated with significantly reduced risk of revision in the 25.0-29.9 (HR 0.79, P=0.046) BMI group. Revision due to pseudarthrosis was reduced in BMI 35.0-39.9 (HR 0.69, P=0.014) and ≥40.0 (HR 0.73, P=0.041), while revision for mechanical failure was lower in BMI 35.0-39.9 (HR 0.65, P=0.013) and ≥40.0 (HR 0.57, P=0.003).

CONCLUSION: GLP-1 RA use was linked with reduced perioperative and long-term surgical complications in patients undergoing thoracic and/or lumbar fusions for degenerative spine disease, particularly in those with BMI ≥25. This risk reduction may be attributed to weight loss and/or the systemic metabolic, inflammatory, and vascular benefits of these medications.

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