Research Summary

GLP-1 Receptor Agonists and Postoperative Outcomes After Spinal Fusion

Miranda Manier, BA

Key Highlights

  • After matching, glucagon-like peptide-1 receptor agonist (GLP-1 RA) use was linked to reduced postoperative infections and fewer readmissions.
  • Revision surgery was less frequent among GLP-1 RA users.
  • Mobility outcomes improved with GLP-1 RAs; fracture rates did not differ significantly.
  • Benefits were observed in both obese and non-obese diabetic patients undergoing spinal fusion.

Cohort analyses showed that GLP-1 receptor agonist (GLP-1 RA) use was associated with improved postoperative outcomes after spinal fusion. After propensity matching, GLP-1 RA users had lower hazards of infection, readmission, and revision, with favorable quality-of-life measures, and no increase in postoperative fractures.

Spinal fusion is widely performed, and a substantial proportion of candidates have obesity or diabetes—factors linked to higher rates of infection, reoperation, and other adverse outcomes. GLP-1 RAs, increasingly used for diabetes and weight management, have emerging musculoskeletal relevance, yet evidence specific to spinal fusion has been limited.

This retrospective, multicenter study used the TriNetX Research Network to identify adults with type 2 diabetes who underwent spinal arthrodesis (2008–2022). Patients were stratified by obesity (BMI ≥30 vs <30 kg/m²) and GLP-1 RA exposure. Propensity score matching (1:1) balanced cohorts on demographics, BMI, hemoglobin A1c (HbA1c), comorbidities, and surgical intervention. Primary outcomes were postoperative infection, readmission, revision surgery, and quality-of-life metrics (muscle weakness, gait/mobility abnormalities); hazard ratios (HRs) were calculated.

After matching, 2263 patients were analyzed, including 1560 patients with obesity. GLP-1 RA use was associated with lower infection hazards in patients with obesity (HR, 0.168; 95% CI, 0.086–0.328) and in patients without obesity (HR, 0.250; 95% CI, 0.102–0.612). Readmissions were reduced in both groups (patients with obesity: HR, 0.283; 95% CI, 0.243–0.329; patients without obesity: HR, 0.241; 95% CI, 0.193–0.301). Revision procedures were less frequent among GLP-1 RA users (patients with obesity: HR, 0.505; 95% CI, 0.368–0.693; patients without obesity: HR, 0.439; 95% CI, 0.272–0.708). Quality-of-life outcomes favored GLP-1 RA exposure, with fewer gait and mobility abnormalities in patients with obesity (HR, 0.355; 95% CI, 0.230–0.549) and in patients without obesity (HR, 0.508; 95% CI, 0.269–0.959), and less generalized muscle weakness in patients with obesity (HR, 0.409; 95% CI, 0.222–0.755). Back pain did not differ in the obesity cohort but was lower among patients without obesity who used GLP-1 RAs (HR, 0.480; 95% CI, 0.258–0.895). Postoperative fracture rates were not significantly different between users and non-users. In descriptive follow-up data, GLP-1 RA groups showed modest 1-year improvements in BMI and HbA1c.

This study is limited by its retrospective design and reliance on ICD-10 and CPT coding, which may not capture the full heterogeneity of spinal fusion procedures. Additional unmeasured variables such as regional differences, socioeconomic factors, surgical approaches, and potential coding inaccuracies may also affect precision. The TriNetX platform’s minimum patient threshold restricts statistical robustness, and pharmacologic uncertainty remains because outcomes cannot be directly attributed to GLP-1 RA–induced bone remodeling. Retrospective data further limit assessment of GLP-1 RA dosage, adherence, and timing of initiation. Although both GLP-1 RA groups showed HbA1c improvement at 1 year, higher baseline levels suggest residual confounding.

“GLP-1 RA use in spinal fusion patients was associated with improved postoperative outcomes, including lower infection rates, fewer revisions, and better quality of life metrics,” Wiener and colleagues concluded. “These findings suggest that GLP-1 RAs may be a valuable adjunctive therapy in managing surgical outcomes in diabetic and obese patients undergoing spinal fusion.”

Reference:
Wiener JM, Sanghvi PA, Vlastaris K, et al. Glucagon-like peptide-1 receptor agonist medications alter outcomes of spine surgery: a study among over 15,000 patients. Spine (Phila Pa 1976). 2025;50(13):871-880. doi:10.1097/BRS.0000000000005283