39. Effect of semaglutide on 90-day and 2-year surgical and medical complications in diabetic patients undergoing anterior cervical discectomy and fusion

Abstract

BACKGROUND CONTEXT

Semaglutide, a glucagon-like peptide-1 receptor agonist, has shown efficacy in improving glycemic control and promoting weight reduction in diabetic patients. However, its impact on postoperative outcomes, particularly in the context of spinal surgeries, remains uncertain. While studies on lumbar fusion procedures have yielded mixed results, some suggest that semaglutide may influence bone turnover and muscle mass, which could affect the healing process following spinal fusion. One study indicated an increased risk of requiring additional surgeries post-transforaminal lumbar interbody fusion (TLIF). In contrast, others noted reduced complications following single-level posterior lumbar fusion, including fewer emergency department visits and adverse events. These inconsistencies point to the need for further research to clarify the effects of semaglutide on surgical outcomes in spinal fusion procedures, specifically in the context of anterior cervical discectomy and fusion (ACDF).

PURPOSE

The purpose of this study is to evaluate the impact of semaglutide on 90-day and 2-year surgical and medical complications in diabetic patients undergoing ACDF.

STUDY DESIGN/SETTING

A retrospective cohort study.

PATIENT SAMPLE

N/A

OUTCOME MEASURES

N/A

METHODS

A retrospective cohort study was conducted utilizing the TriNetX research network, a comprehensive healthcare database. Diabetic patients undergoing ACDF were divided into two groups based on their use of semaglutide: Cohort 1 (patients prescribed semaglutide at the time of surgery) and Cohort 2 (patients with no history of semaglutide use). Propensity score matching was applied to balance the two groups' baseline demographic and clinical characteristics. Surgical and medical outcomes, including both early (90-day) and long-term (2-year) complications, were compared between the two cohorts. The primary outcomes assessed were major medical and surgical complications, and the risk ratios (RR) were calculated for each complication at both 90-day and 2-year intervals.

RESULTS

At the 90-day postoperative mark, no significant differences were found between the two groups for any of the complications analyzed. However, at the 2-year follow-up, semaglutide use was associated with a significant reduction in three major complications: mortality, pseudarthrosis, and general postoperative mechanical complications. Specifically, semaglutide use was linked to lower odds of mortality (2.6% vs 5.2%, RR = 0.487, 95% CI = 0.253 - 0.935, P = 0.028), a decrease in pseudarthrosis rates (6.7% vs 12.9%, RR = 0.487, 95% CI = 0.319 - 0.743, P = 0.001), and a reduction in general post-operative mechanical complications (11.4% vs 17.8%, RR = 0.596, 95% CI = 0.421 - 0.843, P = 0.003).

CONCLUSIONS

The use of semaglutide in diabetic patients undergoing ACDF was associated with a significant reduction in mortality, pseudarthrosis, and general postoperative mechanical complications at 2 years. These findings suggest that semaglutide may offer protective benefits for patients undergoing cervical spine surgery, particularly in terms of long-term recovery and complication reduction. Although no significant differences were observed in 90-day complications, the 2-year results indicate that semaglutide could play an important role in improving surgical outcomes. Further prospective studies are necessary to confirm these findings and explore the broader impact of semaglutide on spinal fusion procedures.

FDA Device/Drug Status

Semaglutide (Approved for this indication).