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

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.