Research Summary

Does Semaglutide Influence Surgical Outcomes and Costs Following Posterior Cervical Fusion?

Anthony Calabro, MA

Key Highlights

  • Semaglutide use increased the odds of pseudoarthrosis and dysphagia at 2 years postoperatively.
  • Same-day costs ($5,000 vs $11,700) and 90-day mean costs ($12,200 vs $18,800) were significantly lower in semaglutide users.
  • No differences were observed in emergency department visits or hospital readmissions.

In a large retrospective study, semaglutide use was associated with a significantly higher risk of surgical complications after posterior cervical fusion (PCF), while also being associated with lower hospital costs in the immediate postoperative period.

At 2 years, semaglutide users demonstrated more than a four-fold increased likelihood of pseudoarthrosis (odds ratio [OR], 4.79; 95% CI, 3.11–7.37; P < .001) and more than twice the odds of dysphagia (OR, 2.12; 95% CI, 1.46–3.03; P < .001).

In contrast, early hospital expenditures were markedly lower in the semaglutide cohort, with same-day costs averaging $5000 compared with $11,700 in controls (P < .001) and 90-day mean costs of $12,200 compared with $18,800 (P <. 001). No significant differences were observed in emergency department visits or readmission rates.

While semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated efficacy in glycemic control and weight management, its influence on perioperative and long-term outcomes in spine surgery remains underexplored. Given the increasing prevalence of semaglutide prescriptions, understanding its potential impact on PCF outcomes is essential for improving surgical planning and patient counseling.

To evaluate this association, researchers performed a retrospective cohort study using the PearlDiver Mariner database, identifying patients undergoing PCF between 2010 and 2022. Those with an active semaglutide prescription were matched to controls in a 1:5 ratio using propensity scores based on demographic and clinical characteristics, including age, sex, and Elixhauser Comorbidity Index. Outcomes included postoperative complications, readmissions, emergency department visits, and hospital costs within 90 days and 2 years. Analyses were conducted with chi-square testing and logistic regression, with Bonferroni-corrected significance set at P < .003.

From the 1880 matched patients (340 semaglutide users, 1540 controls), results consistently pointed to a divergence between complication risks and financial outcomes. Whereas long-term surgical complications were more prevalent in semaglutide users, short-term costs were significantly reduced, suggesting a complex clinical and economic profile associated with perioperative semaglutide use.

“Semaglutide use is associated with an increased risk of long-term complications, including pseudoarthrosis and dysphagia, as well as lower same-day and 90-day costs in patients undergoing PCF,” the authors concluded. “These findings highlight the importance of careful perioperative management of semaglutide users to optimize outcomes while leveraging its purported benefits.”

Reference
Ng MK, Mastrokostas PG, Mastrokostas LE, et al. Semaglutide use is associated with higher rates of pseudarthrosis and dysphagia in patients undergoing posterior cervical fusion. Spine J. 2025;25(9):1974-1980. doi:10.1016/j.spinee.2025.03.023