Perioperative Glucagon-like Peptide-1 Receptor Agonist Use Is Associated With Lower Pseudoarthrosis Rates Following Long-Segment Spinal Deformity Correction: A Propensity-Matched Analysis

Study Design Retrospective Cohort Study Objective This study investigated the association between perioperative glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy and pseudoarthrosis rates in patients undergoing long-segment spinal deformity surgery. Methods Adult patients with a history of spinal deformity who underwent posterior segmental instrumentation spanning seven or more levels between 7/1/2010 and 7/1/2024 were identified. Patients prescribed a GLP-1 RA within six months before or after surgery comprised the experimental group; patients without GLP-1 RA use comprised the control group. Cohorts were balanced 1:1 by demographic characteristics and medical comorbidities. The primary outcome was the clinical diagnosis of pseudoarthrosis at 6 months, 1 year, 2 years, and 3 years following the index procedure; relevant 90-day medical complications were also assessed using risk ratios (RR) and 95% confidence intervals. Results Perioperative GLP-1 RA use was associated with a significant reduction in risk of pseudoarthrosis at 6 months (RR 0.677, P = .028 ), one year (RR 0.708, P = .036 ), two years (RR = 0.671, P = 0.010 ), and three years (RR = 0.714, P = .024 ) following the index procedure. Perioperative GLP-1 RA use was also associated with a significant reduction in hospital readmission (RR 0.863, P = .012 ) and sepsis (RR 0.485, P = .002 ) within 90 days following the index procedure. Conclusions This study supports the potential protective effect of GLP-1 RAs against the risk of pseudoarthrosis in patients who underwent long-segment spine deformity surgery. Further, perioperative GLP-1 RA therapy was not associated with increased risk of medical complications in the 90-day postoperative period and may reduce hospital readmission and sepsis.