GLP-1 receptor agonists linked to higher spine fusion success, no increased perioperative complications
Background
The rising prevalence of obesity and Type 2 Diabetes Mellitus (T2DM) often necessitates spine surgery, particularly fusion procedures, which carry risks of perioperative complications and pseudoarthrosis. Patients with these metabolic conditions frequently use glucagon-like peptide-1 receptor agonists (GLP-1RAs). Prior studies on GLP-1RA use in spine surgery have yielded mixed results regarding their impact on outcomes. Understanding this association is crucial for optimizing perioperative management and patient counseling, especially given the potential for GLP-1RAs to influence metabolic and inflammatory pathways relevant to healing.
Study Design
Researchers conducted a systematic review and meta-analysis, following PRISMA 2020 guidelines, by searching PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library through December 2025. They included comparative studies evaluating spine surgery outcomes in patients exposed to GLP-1RAs versus non-users. Random-effects meta-analyses were performed for perioperative outcomes, medical and surgical complications, reoperation, and fusion-related outcomes. Subgroup analyses considered diabetes status, fusion levels, and duration of follow-up.
Results
The analysis included 20 comparative studies with a total of 546,668 patients. GLP-1RA use was not associated with significant differences in several key perioperative or postoperative outcomes. Specifically, no significant differences were found for transfusion (logOR = -0.25, 95% CI: -0.67, 0.17), operative time (MD = -5.3 min, 95% CI: -23.9, 13.3), length of stay (MD = -0.19 days, 95% CI: -1.35, 0.96), surgical site infection (logOR = 0.29, 95% CI: -0.08, 0.66), venous thromboembolism (logOR = 0.19, 95% CI: -0.25, 0.63), readmission (logOR = 0.31, 95% CI: -0.07, 0.69), reoperation (logOR = 0.12, 95% CI: -0.17, 0.42), or implant failure. In contrast, a significant positive association was observed for fusion success:
GLP-1RA use was associated with higher fusion success (logOR = 0.42, 95% CI: 0.33, 0.51; p < 0.001), a benefit consistent across follow-up intervals.
Key Findings
- GLP-1RA use was not associated with increased perioperative complications like transfusion (logOR = -0.25, 95% CI: -0.67, 0.17).
- No significant differences were found in operative time (MD = -5.3 min, 95% CI: -23.9, 13.3) or length of stay.
- GLP-1RA use did not increase risks of surgical site infection (logOR = 0.29, 95% CI: -0.08, 0.66) or venous thromboembolism.
- GLP-1RA use was associated with higher fusion success (logOR = 0.42, 95% CI: 0.33, 0.51; p < 0.001).
- No association was found between GLP-1RA use and increased reoperation (logOR = 0.12, 95% CI: -0.17, 0.42) or implant failure.
Why It Matters
This meta-analysis provides significant reassurance for GLP-1RA users undergoing spine surgery, indicating no increased perioperative complications. The finding of improved fusion success suggests a potential long-term benefit, which could be particularly impactful for patients with metabolic comorbidities. Clinicians may consider continued GLP-1RA therapy perioperatively without undue concern for adverse events, and potentially leverage its benefits for bone healing. While these findings are promising, prospective studies are still needed to establish causality and define optimal perioperative management strategies, including specific dosing or timing protocols for GLP-1RAs around surgery.
glp-1ra
spine-surgery
fusion
meta-analysis
perioperative-safety
diabetes