Glucagon-Like Peptide-1 Receptor Agonist Use Does Not Impact Spine Surgery Outcomes: A Systematic Review and Meta-Analysis

Study Design Systematic Review and Meta-Analysis. Objectives Despite a surge in the use of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in spine surgery candidates, evidence on their perioperative use remains unclear. This meta-analysis aimed to synthesize the evidence on the safety and efficacy of GLP-1 RA use in patients undergoing spine surgeries. Methods A systematic search of PubMed (MEDLINE), Embase, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Studies that compared spine surgery outcomes in GLP-1 RA users and non-users were included. Two reviewers independently selected articles. (PROSPERO: CRD420251061447). Results Eleven retrospective studies reporting on 27,143 patients were included. Three studies focused on the cervical spine, 6 on the lumbar spine, and 2 included all spinal fusions. Risk of bias was deemed to be low in all studies. There were no significant differences in the GLP-1 RA users and non-users in pooled estimates for pseudoarthrosis (odds ratio: 1.29 95% CI: 0.09 - 19.23), surgical site infections (0.97 0.74 - 1.27), pneumonia (1.19 0.30 - 4.68), deep vein thrombosis (1.34 0.86 - 2.08), acute kidney injury (1.27 0.93 - 1.74), readmission rate (1.06 0.94 - 1.18), and emergency department visits (0.95 0.10 - 8.99). Conclusions Currently available level 4 evidence suggests that perioperative GLP-1 RA use in spine surgery candidates does not affect the risk of postoperative complications. However, these studies are based on administrative databases and may be confounded by indication. Future studies should include glycemic control and weight loss to better elucidate the impact of GLP-1 RA.