The Use of Semaglutide in Patients Undergoing Lumbar Fusion Does not Increase 90-Day Medical or 1-Year Implant Complications

STUDY DESIGN: Retrospective Cohort Study of National Database. OBJECTIVE: This study examines their effect on medical and mechanical complications within 90 days postlumbar spine surgery. SUMMARY OF BACKGROUND DATA: Patients undergoing spinal procedures increasingly use glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally for type 2 diabetes and now popular for weight loss. The impact of GLP-1 RAs on spinal fusion outcomes is unknown. METHODS: This study used medical records from TriNetX, a national deidentified database, to examine diabetic patients undergoing lumbar spine procedures. Patients receiving GLP-1 RAs within 6 months preoperatively were compared with a propensity-matched control group. Propensity score matching (1:1) controlled for demographic factors and comorbidities, including type I and II diabetes, metformin use, and BMI. The study analyzed 90-day medical and 1-year implant complications using χ 2 exact tests and univariate regression in a propensity-matched cohort. RESULTS: The GLP-1 RA cohort and control group included 1110 and 151,440 patients, respectively. Of these, 1090 patients were propensity-matched 1:1 in each cohort. Within 90 days postoperatively, the GLP-1 RA group had higher rates of all-cause anemia (9.4% vs. 7.0%, P =0.016), renal failure (4.4% vs. 2.9%, P =0.028), opioid use (94% vs. 89%, P <0.001), emergency room visits (16% vs. 13%, P =0.013), and wound complications (0.5% vs. 0.2%, P <0.001). Other complications, such as infections, myocardial infarction, pulmonary embolism, deep vein thrombosis, hypoglycemic events, stroke, hospitalization, pneumonia, and transfusion, were similar between groups. One year postoperatively, pseudoarthrosis was less frequent in the GLP-1 RA group (12% vs. 16%, P =0.002). There were no significant differences in hospitalization, adjacent segment disease, mechanical loosening, or postlaminectomy syndrome. CONCLUSION: This study found that the risk of complications in patients receiving GLP-1 RAs before lumbar spine surgery is comparable to control patients, suggesting GLP-1 RAs do not increase adverse outcomes and should not exclude patients from surgery. LEVEL OF EVIDENCE: Level III-therapeutic study.