Association of glucagon-like peptide-1 receptor agonist use with patient-reported outcomes after lumbar decompression or fusion

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly prescribed for diabetes and obesity, conditions that are common among patients undergoing lumbar surgery. Prior studies suggest comparable or improved complication rates among GLP-1 users; however, the association between GLP-1 use and patient-reported outcome measures (PROMs) following lumbar surgery remains unclear. Methods: This retrospective cohort study included patients undergoing lumbar decompression or instrumented posterolateral fusion from 2020 to 2025 at a single institution with 2 surgeons. Included patients completed Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) surveys preoperatively and at a minimum of 6 months postoperatively. Patients using GLP-1 agonists at surgery were propensity score matched 1:2 to nonusers based on age, sex, body mass index, Charlson Comorbidity Index (CCI), diabetes status, procedure type, and number of operative levels. Primary outcomes included PROMIS-PF scores and achievement of minimal clinically important difference (MCID). Secondary outcomes included PROMIS Global Mental Health (MH), length of stay, discharge disposition, 30-day emergency department visits, and readmissions. Weighted linear and logistic regression models were used to evaluate outcomes, incorporating inverse probability of censoring weights to account for differential 1-year follow-up. Results: The matched cohorts included 80 GLP-1 users and 160 nonusers. GLP-1 users had a slightly lower CCI (3.2 ± 1.5 vs. 3.8 ± 2.1; p = .011). PROMIS-PF scores were similar at all time points, and rates of MCID achievement were similar between groups (56.2% vs. 51.9%, p = .615). PROMIS-MH scores were similar at all time points, though GLP-1 users demonstrated higher MH MCID achievement (53.8% vs. 37.0%, p = .040). These findings remained consistent in the weighted multivariate models. Subgroup analyses by procedure type showed no differences in PROMs at any time point. No differences were observed in perioperative or clinical outcomes. Conclusions: In this single-institution cohort of patients undergoing lumbar decompression or fusion, GLP-1 agonist use was not associated with differences in postoperative functional recovery or complication rates. While a higher proportion of GLP-1 users achieved clinically meaningful improvement in MH, only modest improvements were observed on average. Overall, these results suggest that GLP-1 agonist use does not meaningfully alter PROMs following lumbar spine surgery.