Perioperative SGLT2 Inhibitor Use is Associated With Improved Outcomes After ACDF: A Propensity-matched Analysis

Area of Science:

• Nephrology
• Endocrinology
• Orthopedic Surgery

Background:

• Sodium-glucose cotransporter-2 inhibitors (SGLT2i) offer cardiorenal benefits beyond glycemic control in diabetic patients.
• Limited data exists on the perioperative impact of SGLT2i in patients undergoing anterior cervical discectomy and fusion (ACDF).

Purpose of the Study:

• To evaluate the association between perioperative SGLT2i use and short-term postoperative complications and long-term outcomes after ACDF.

Main Methods:

• Retrospective cohort study utilizing the TriNetX database.
• 1,585 patients undergoing ACDF were propensity score matched and stratified by preoperative SGLT2i use.
• Outcomes assessed included postoperative events and long-term sequelae, with statistical analysis using risk ratios and Kaplan-Meier curves.

Main Results:

• The SGLT2i cohort showed significantly lower rates of postoperative emergency department visits (RR 0.59, P=0.047).
• At 1-year follow-up, SGLT2i use was associated with reduced pseudoarthrosis rates (RR 0.73, P=0.028).
• Five-year reoperation rates were also lower in the SGLT2i group (RR 0.64, P=0.033), with no significant differences in other major complications.

Conclusions:

• Preoperative SGLT2i use is associated with decreased postoperative emergency department utilization and lower rates of early pseudoarthrosis after ACDF.
• No increased risk of short-term complications was observed.
• Findings should guide preoperative counseling and postoperative care planning for ACDF patients on SGLT2i.