Association Between Preoperative GLP-1 Receptor Analog Use and Postoperative Complications and Mortality Following Lumbar Fusion Surgery

TL;DR

Using GLP-1 receptor antagonists before lumbar fusion surgery may reduce postoperative complications and mortality.

Contribution

This study is the first to show that preoperative GLP-1 RA use is linked to fewer postoperative complications after lumbar fusion.

Findings

GLP-1 RA users had lower rates of DVT, PE, sepsis, pneumonia, pseudoarthrosis, and all-cause mortality.

Propensity score matching ensured balanced comparison between users and non-users.

Findings suggest potential benefits of GLP-1 RAs in surgical outcomes, though mechanisms remain unclear.

Abstract

Retrospective Cohort Study.

This study evaluates the association between preoperative GLP-1 RA (glucagon-like-peptide-1 receptor antagonist) use and postoperative outcomes in patients undergoing lumbar fusion surgery.

TriNetX database identified patients undergoing lumbar fusion within 20 years using Current Procedural Terminology (CPT). Patients were categorized by GLP-1 RA use within 1 year preoperatively. 1:1 propensity score match (PSM) balanced demographics and comorbidities including race/ethnicity, age, gender, hypertension, diabetes, obesity, nicotine dependence, sleep apnea, ischemic heart diseases, chronic kidney disease, acute kidney failure, mood disorders, asthma, chronic obstructive pulmonary disease, heart failure, alcohol dependence, anemia, and vitamin D deficiency. Primary outcomes were 1-year complications postoperatively. Chi-square analysis, risk ratios (RRs), 95% confidence intervals (CI), and P-values were calculated; significance was P < 0.05.

4331 patients using preoperative GLP-1 RA were propensity score-matched with 179,268 controls without GLP-1 RA use, resulting in 4331 patients in each cohort after matching. At 1 year, GLP-1 RA users had significant reductions in DVT (1.4% vs 2.3%, RR = 0.64, 95% CI [0.464-0.883], P = 0.0061), PE (1.1% vs 1.6%, RR = 0.689, 95% CI [0.476-0.997], P = 0.0466), sepsis (4.0% vs 5.0%, RR = 0.811, 95% CI [0.66-0.995], P = 0.0447), all-cause mortality (2.1% vs 4.6%, RR = 0.46, 95% CI [0.36-0.589], P < 0.0001), pneumonia (2.4% vs 3.3%, RR = 0.716, 95% CI [0.548-0.936], P = 0.0139), and pseudoarthrosis (8.9% vs 13.8%, RR = 0.642, 95% CI [0.564-0.732], P < 0.0001) compared to non-users.

Preoperative GLP-1 RA use is associated with a reduction in postoperative complications following lumbar fusion surgery. Further research is necessary to elucidate the underlying mechanisms and evaluate long-term outcomes.

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