Impact of Preoperative Glucagon-Like Peptide-1 Receptor Agonist Use on Short-Term and Long-Term Outcomes Following Thoracic and/or Lumbar Fusion for Spinal Deformity: A BMI-Stratified Cohort Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Study design: A retrospective cohort study. Objective: To evaluate the association between preoperative use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and postoperative outcomes following thoracic and/or lumbar fusion for spinal deformity, stratified by body mass index (BMI). Summary of background data: Thoracic and lumbar fusion surgeries are increasingly performed to treat spinal deformities, particularly among older and obese populations. GLP-1 RAs, originally developed for diabetes management, are now commonly prescribed for weight loss across a wide BMI range. Although these agents have shown systemic metabolic and anti-inflammatory benefits, their effects on spine surgery outcomes remain poorly characterized. Methods: A retrospective analysis of a national claims database (2010–2023) was conducted. Patients undergoing thoracic and/or lumbar fusion for spinal deformity were identified and stratified into six BMI categories. GLP-1 RA users were identified through preoperative pharmacy claims and matched 1:4 to nonusers based on age, sex, and Charlson Comorbidity Index. Primary endpoints included 90-day medical complications and 2-year and 10-year surgical outcomes. Cox proportional hazards models were used to assess long-term risks, with Bonferroni correction applied for multiple comparisons. Results: Of 214,922 patients, 14,047 GLP-1 RA users were matched to 56,056 controls. GLP-1 RA use was associated with significantly lower rates of 90-day complications—including infections, pneumonia, venous thromboembolism, and sepsis—in patients with BMI ≥25. No significant differences were observed in 2-year or 10-year rates of revision for infection, pseudoarthrosis, or mechanical failure. However, GLP-1 RA users exhibited a consistently increased risk of decompressive laminectomy at both 2 and 10 years across all BMI categories. Conclusion: Preoperative use of GLP-1 RAs is associated with improved short-term postoperative outcomes following thoracic and/or lumbar fusion, particularly in overweight and obese patients. The observed increase in long-term rates of decompressive laminectomy warrants further investigation to elucidate potential skeletal effects and underlying mechanisms. Level of Evidence: Level III.
Source: Spine Open
Authors: Harmon S. Khela, Arman Kishan, Alex H. Manriquez, Lachlan Kirby, Zvipo Chisango, Nicolas L. Carayannopoulos, Manjot Singh, Ethan J. Cottrill, Raffi S. Avedian, Christopher J. Kleck, Christopher I. Shaffrey, Andrew J. Schoenfeld, William C. Eward, Peter G. Passias, Alan H. Daniels, Pawel P. Jankowski
Institutions: University of Pennsylvania, Duke University, Duke Medical Center, Columbia University, Brown University, Rutgers, The State University of New Jersey, Stanford Medicine, Stanford University, University of Colorado Anschutz, University of Colorado Denver, Harvard University, Mass General Brigham, Hoag Memorial Hospital Presbyterian
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7123944464