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Do glucagon-like peptide-1 receptor agonists influence cervical fusion outcomes? A systematic review and
Matheus Loiola Magalhães Alves1, Antônio Olímpio da Silva Moura Costa2, Julia do Vale Moura Costa3
1Department of Medicine, Zarns College, Avenida Luís Viana Filho, 3230, Imbuí, Salvador, Bahia 41720-200, Brazil.
Background:
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in patients with obesity and type 2 diabetes, but their procedure-specific effects in cervical fusion remain unclear.
Methods:
A systematic review and meta-analysis following PRISMA 2020 and MOOSE, prospectively registered in PROSPERO, searched PubMed, Embase, and Web of Science through April 28, 2026. Comparative studies evaluating perioperative GLP-1RA use in adults undergoing cervical fusion were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed in Review Manager Web (RevMan Web). Certainty of evidence was assessed using the GRADE approach for clinically important outcomes.
Results:
Six propensity score-matched retrospective cohort studies involving 17,310 patients were included. In the primary analyses, GLP-1RA use was not associated with significant differences in pseudarthrosis (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.33-2.89; p = .96), dysphagia (OR 0.89, 95% CI 0.38-2.05; p = .68), hospital readmission (OR 0.67, 95% CI 0.39-1.17; p = .12), or device failure (OR 0.83, 95% CI 0.44-1.56; p = .41). Secondary outcomes were also not significantly different between groups.
Conclusions:
Perioperative GLP-1RA use was not associated with a consistent pattern of worse postoperative outcomes after cervical fusion. Prospective, procedure-specific studies with standardized exposure and outcome definitions are needed.
