STUDY DESIGN: Retrospective cohort study.
OBJECTIVE: To investigate the relationship between perioperative glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and postoperative outcomes after spinal fusion in obese and diabetic patient populations.
BACKGROUND: GLP-1 RAs have been shown to be beneficial when used perioperatively in clinical orthopedic arthroplasty literature. Minimal evidence exists showing efficacy with respect to spinal fusion.
MATERIALS AND METHODS: This retrospective, multi-center study accessed the TriNetX platform, using the research database to identify diabetic patients who underwent spinal fusion between 2008 and 2022. Cohorts were created based on body mass index and GLP-1 RA usage. Propensity score matching was employed to create balanced cohorts utilizing body mass index, hemoglobin A1c, surgical intervention, as well as other demographic characteristics. Orthopedic outcomes were compared between GLP-1 RA users and non-users. The primary outcomes included postoperative infection, readmission, revision surgery, and quality of life metrics.
RESULTS: After matching, the study cohort consisted of 2263 patients, with 1560 classified as obese. GLP-1 RA use was associated with significantly reduced postoperative infection rates [obese: HR = 0.168 (0.086, 0.328), not obese: HR = 0.250 (0.102, 0.612)], fewer revisions [obese: HR = 0.505 (0.368, 0.693), not obese: HR = 0.439 (0.272, 0.708)], decreased postoperative readmission rates [obese: HR = 0.283 (0.243, 0.329), not obese: HR = 0.241 (0.193, 0.301)], and reduced mobility abnormalities [obese: HR = 0.355 (0.230, 0.549), not obese: HR = 0.508 (0.269, 0.959)]. No significant differences were observed in rates of fracture rates between GLP-1 RA users and non-users.
CONCLUSIONS: GLP-1 RA use in spinal fusion patients was associated with improved postoperative outcomes, including lower infection rates, fewer revisions, and better quality of life metrics. These findings suggest that GLP-1 RAs may be a valuable adjunctive therapy in managing surgical outcomes in diabetic and obese patients undergoing spinal fusion. Further prospective and animal-based studies are needed to confirm these findings and explore the underlying mechanisms.
