Glucagon-like peptide-1 receptor agonist use prior to spinal surgery results in reduced postoperative length of stay: A propensity-score matched analysis

Abstract

Background

While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated benefits in reducing complications following total knee and hip arthroplasty, their effects in spinal surgery remain unclear. Prior studies have reported mixed results across select spinal fusion procedures, and the impact of GLP-1 RAs on perioperative outcomes has not been well-defined. This study evaluates the association between preoperative GLP-1 RA use and key perioperative outcomes in spinal surgery.

Methods

We conducted a retrospective, propensity score-matched analysis of adult patients (≥18 years) undergoing spinal decompression and/or fusion at an urban academic spine service over the past 5 years. Patients prescribed a GLP-1 RA preoperatively comprised the exposure cohort. A 1:4 nearest-neighbor propensity score matching algorithm was then used to identify comparable controls without GLP-1 RA use, based on age, sex, body mass index (BMI), primary procedure code, comorbidities (diabetes, hypertension, hyperlipidemia, heart disease, smoking status, kidney disease, and anxiety), and the use of prevalent diabetic medications (insulin, metformin, sulfonylureas, and SGLT-2 inhibitors). Primary outcomes included length of stay (LOS), operating room (OPR) time, 90-day reoperation, 90-day readmission, and nonroutine discharge. Binary outcomes were assessed using multivariate logistic regression, while the Mann-Whitney U test was used for continuous variables.

Results

The final matched cohort included 1385 patients (GLP-1 RA: n = 277; control: n = 1,108), with anterior cervical discectomy and fusion being the most common procedure (n = 333, 24%). The GLP-1 RA cohort was predominantly female (n = 172, 62.1%), with a mean age of 61.4 years and mean BMI of 33.8 kg/m². Both cohorts exhibited high rates of comorbidities, including diabetes and hypertension. GLP-1 RA use was associated with a significant reduction in median postoperative LOS (3 days vs. 4 days; p = 0.036), particularly among patients undergoing lumbar fusion. No significant differences were observed in OPR time, 90-day reoperation, 90-day readmission, or nonroutine discharge rates.

Conclusions

Preoperative GLP-1 RA use was associated with a statistically significant reduction in postoperative LOS among patients undergoing spinal decompression and/or fusion. Further prospective, multi-institutional studies are warranted to validate these findings and to determine whether this reduction translates into clinically and financially meaningful benefits, including improved long-term outcomes.