Goldman Samuel N, Mani Kyle, Scharfenberger Thomas, Kleinbart Emily, Hui Aaron T, De la Garza Ramos Rafael, Fourman Mitchell S, Eleswarapu Ananth S
Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, United States.
Department of Neurological Surgery, Montefiore Einstein, Bronx, NY, United States.
N Am Spine Soc J. 2025 Apr 18;22:100612. doi: 10.1016/j.xnsj.2025.100612. eCollection 2025 Jun.
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.
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.
The final matched cohort included 1385 patients (GLP-1 RA: = 277; control: = 1,108), with anterior cervical discectomy and fusion being the most common procedure ( = 333, 24%). The GLP-1 RA cohort was predominantly female ( = 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.
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.
虽然胰高血糖素样肽-1受体激动剂（GLP-1 RAs）已证明在降低全膝关节和髋关节置换术后并发症方面有益，但其在脊柱手术中的效果仍不清楚。先前的研究报告了在选定的脊柱融合手术中的结果不一，并且GLP-1 RAs对围手术期结局的影响尚未明确界定。本研究评估脊柱手术中术前使用GLP-1 RAs与关键围手术期结局之间的关联。
我们对过去5年在城市学术脊柱服务机构接受脊柱减压和/或融合手术的成年患者（≥18岁）进行了一项回顾性、倾向评分匹配分析。术前开具GLP-1 RA的患者组成暴露队列。然后使用1:4最近邻倾向评分匹配算法，根据年龄、性别、体重指数（BMI）、主要手术编码、合并症（糖尿病、高血压、高脂血症、心脏病、吸烟状况、肾病和焦虑症）以及常用糖尿病药物（胰岛素、二甲双胍、磺脲类药物和SGLT-2抑制剂）的使用情况，识别未使用GLP-1 RA的可比对照组。主要结局包括住院时间（LOS）、手术室（OPR）时间、90天再次手术、90天再入院和非常规出院。二元结局使用多变量逻辑回归进行评估，连续变量使用曼-惠特尼U检验。
最终匹配队列包括1385例患者（GLP-1 RA组：n = 277；对照组：n = 1,108），前路颈椎间盘切除融合术是最常见的手术（n = 333，24%）。GLP-1 RA组以女性为主（n = 172，62.1%），平均年龄61.4岁，平均BMI为33.8 kg/m²。两组均表现出较高的合并症发生率，包括糖尿病和高血压。使用GLP-1 RA与术后中位LOS显著缩短相关（3天对4天；p = 0.036），尤其是在接受腰椎融合术的患者中。在OPR时间、90天再次手术、90天再入院或非常规出院率方面未观察到显著差异。
脊柱减压和/或融合手术患者术前使用GLP-1 RA与术后LOS在统计学上显著缩短相关。需要进一步的前瞻性、多机构研究来验证这些发现，并确定这种缩短是否转化为临床和财务上有意义的益处，包括改善长期结局。
