BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may reduce surgical risks through metabolic and anti-inflammatory benefits, but their evidence in spine surgery remains mixed.
PURPOSE: We sought to compare postoperative outcomes and healthcare use after lumbar discectomy between GLP-1 RA users and 2 control cohorts: obese and normal body mass index (BMI) patients.
METHODS: Adults with lumbar disk herniation undergoing single-level discectomy (2010-2023) were identified in the PearlDiver database. Three cohorts were created: (1) GLP-1 RA users (N = 540); (2) obese controls (N = 63 445); and (3) normal-BMI controls (N = 96,965). After propensity score matching (PSM), 539 GLP-1 RA users were matched with 539 obese controls on age, sex, Charlson Comorbidity Index (CCI), diabetes mellitus, and tobacco use. Two-tailed-tests and χtests were performed for pairwise comparisons between unmatched and matched GLP-1 RA users and obese controls. t2
RESULTS: Compared to obese controls, GLP-1 RA users demonstrated lower rates of 90-day medical complications, such as pneumonia, that persisted after PSM, and lower rates of 90-day emergency department visits before and after PSM. In addition, GLP-1 RA users demonstrated lower rates of hospital readmissions compared to obese controls, before and after PSM. GLP-1 RA users incurred higher total 90-day costs, but this did not persist after PSM. While GLP-1 RA users had higher 2-year revision discectomy rates than matched obese controls (4.1% vs 2.4%), this difference was not statistically significant.
CONCLUSION: After PSM on demographics and select comorbidities, preoperative GLP-1 RA exposure was associated with lower 90-day medical complications, unplanned ED visits, and readmissions following single-level lumbar discectomy compared to obese controls. Revision discectomy and lumbar fusion rates were not significantly different after matching. Future research is needed to guide perioperative management of GLP-1 RA medications.
LEVEL OF EVIDENCE: Level III, Retrospective comparative cohort study.
