Do GLP-1 Receptor Agonists Influence Cervical Fusion Outcomes? A Systematic Review and Meta-Analysis

Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in patients with obesity and type 2 diabetes, but their procedure-specific effects in cervical fusion remain unclear. Methods A systematic review and meta-analysis following PRISMA 2020 and MOOSE, prospectively registered in PROSPERO, searched PubMed, Embase, and Web of Science through April 28, 2026. Comparative studies evaluating perioperative GLP-1RA use in adults undergoing cervical fusion were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed in Review Manager Web (RevMan Web). Certainty of evidence was assessed using the GRADE approach for clinically important outcomes. Results Six propensity score-matched retrospective cohort studies involving 17,310 patients were included. In the primary analyses, GLP-1RA use was not associated with significant differences in pseudarthrosis (OR 0.98, 95% CI 0.33–2.89; p = 0.96), dysphagia (OR 0.89, 95% CI 0.38–2.05; p = 0.68), hospital readmission (OR 0.67, 95% CI 0.39–1.17; p = 0.12), or device failure (OR 0.83, 95% CI 0.44–1.56; p = 0.41). Secondary outcomes were also not significantly different between groups. Conclusions Perioperative GLP-1RA use was not associated with a consistent pattern of worse postoperative outcomes after cervical fusion. Prospective, procedure-specific studies with standardized exposure and outcome definitions are needed.