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The Impact of GLP-1 Receptor Agonists on Outcomes in Nondiabetic Patients Undergoing Posterior Cervical Spine
Nicole M Rivera1, Taylor Bradley2, Ethan Cottrill2
1Duke University School of Medicine.
Study Design:
Retrospective cohort study.
Objective:
To evaluate postoperative outcomes following posterior cervical spine surgery among nondiabetic patients prescribed glucagon-like peptide-1 (GLP-1) receptor agonists compared with a matched cohort not receiving GLP-1 therapy.
Summary Of Background Data:
Obesity increases the risk of complications after posterior cervical spine surgery, including wound complications, infection, and venous thromboembolism. Lifestyle-based weight management is often difficult to sustain, while bariatric surgery achieves durable weight loss but carries risks of malabsorption and nutritional deficiencies. GLP-1 receptor agonists, originally developed for the management of diabetes, are increasingly prescribed for weight loss in nondiabetic patients, making it important to clarify their perioperative implications. The impact of GLP-1s on outcomes after posterior cervical procedures in nondiabetic patients remains unclear.
Methods:
The PearlDiver Mariner database (2010-2023) was queried for nondiabetic patients undergoing posterior cervical spine surgery. Patients prescribed GLP-1s were 1:1 propensity-matched to controls by demographics and comorbidities. Surgical and medical outcomes were assessed at 90 days. Long-term outcomes, including mortality at 1-year and 2-year revision, surgical site infection, and deep infection, were assessed. Odds ratios (ORs) were created using logistic regression analyses.
Results:
A total of 136,571 nondiabetic patients underwent posterior cervical surgery. After matching, 1,719 patients were included in each cohort. GLP-1 use was associated with reduced odds of emergency department visits (OR: 0.71; 95% CI: 0.58-0.87; P=0.001) and hospital admission (OR: 0.54; 95% CI: 0.41-0.70; P<0.001) within 90 days. No significant differences were observed in other complications at 90 days or 2 years.
Conclusion:
GLP-1 use in nondiabetic patients was associated with reduced emergency department utilization and hospital admission within 90 days of posterior cervical spine surgery. GLP-1 therapy was not associated with increased complication risk, supporting its perioperative safety and suggesting a potential role in perioperative optimization in this population.
