Are GLP-1 Receptor Agonists Safe in Spine Surgery
Iyan Younus, Rafael Garcia de Oliveira, Takeshi Fujii, Aiyush Bansal, Patricia Lipson, Rajiv K. Sethi, Venu M. Nemani, Jean‐Christophe Leveque, Philip K. Louie
Abstract
STUDY DESIGN: Systematic review. OBJECTIVE: The objective of this study is to: 1) systematically review Glucagon-like peptide-1 receptor agonists (GLP-1 RA) impact on spine surgery outcomes 2) review general benefits and adverse effects, and 3) discuss considerations for perioperative management. SUMMARY OF BACKGROUND DATA: GLP-1 RAs have gained popularity given their significant benefits in glycemic control and weight loss. There remains a paucity of data on the safety of GLP-1 RAs in spine surgery. METHODS: A literature review using PubMed and Embase with the following keywords was performed: GLP-1 RAs; semaglutide; spine surgery; spinal fusion; interbody fusion; cervical; thoracic; lumbar. A systematic review was conducted to assess GLP-1 RAs utilization in spine surgery. RESULTS: Ten retrospective studies met inclusion criteria producing mixed results on the impact of GLP-1 RAs in spine surgery. Studies had varying follow up and wide heterogeneity in methodology with different surgical procedures and outcomes studied. In regard to medical complications, 1 study reported favorable outcomes, 1 reported equivocal outcomes, and 1 reported worse outcomes in the GLP-1 RA cohort. In regard to operative outcomes, 2 studies were favorable, 1 study was equivocal, and 1 study reported adverse outcomes. For readmissions, the GLP-1 RA cohort had positive outcomes in 1 study and equivocal outcomes in 4 studies. In regard to pseudarthrosis, the GLP-1 RA cohort had lower odds of pseudarthrosis in 4 studies and higher odds in 1 study. CONCLUSION: This review highlights the current understanding of GLP-1 RA's impact on spine surgery. Retrospective studies demonstrate mixed and contradictory results on the impact of GLP-1 RAs on medical complications, operative outcomes, readmission, and pseudarthrosis. These studies are limited by potential unmeasured confounders and do not establish a causal relationship highlighting the need for future prospective studies to better understand the impact of GLP-1 RAs on spine surgery.