Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Complications Following Thoracic and/or Lumbar Spinal Fusion for Degenerative Spine Disease: A BMI-Stratified Retrospective Study

Retrospective cohort. Spinal fusions are common interventions for degenerative spine disease (DSD), with increasing utilization in obese and metabolic syndrome populations. Glucagon-like peptide-1 (GLP-1) receptor agonists (RA), widely adopted for diabetes and weight management, may offer systemic benefits that exert a parallel influence on surgical outcomes. We aimed to evaluate whether preoperative GLP-1 RA use influences 90-day medical and 2- and 10-year surgical complications following thoracic and/or lumbar spinal fusion for DSD, stratified by BMI. Using a national claims database (2010-2023), we identified patients undergoing thoracic and/or lumbar spinal fusion for degenerative conditions. GLP-1 RA users within 6 months pre-op were 4:1 matched to controls by age, sex, and CCI across six BMI strata. Outcomes included 90-day medical and 2- and 10-year surgical complications (eg, revisions for infection, pseudoarthrosis, and mechanical failure). χ 2 , t tests, and Cox models were used for statistical analysis. Among 291,677 patients, 19,232 GLP-1 RA users were matched to 76,778 controls. Ninety-day medical complications-such as infection, pneumonia, thromboembolism, sepsis, stroke, and UTI-were significantly reduced in GLP-1 RA users across BMI categories ≥25. Two-year surgical complications were lower among GLP-1 RA users in BMI 35 ti 39.9 (1.1% vs . 1.6%, P =0.007 for pseudarthrosis-related revision; 0.8% vs . 1.2%, P =0.038 for mechanical failure) and ≥40 groups. At 10 years, GLP-1 RA use was associated with significantly reduced risk of revision in the 25.0 to 29.9 (HR 0.79, P =0.046) BMI group. Revision due to pseudarthrosis was reduced in BMI 35.0 to 39.9 (HR 0.69, P =0.014) and ≥40.0 (HR 0.73, P =0.041), while revision for mechanical failure was lower in BMI 35.0 to 39.9 (HR 0.65, P =0.013) and ≥40.0 (HR 0.57, P =0.003). GLP-1 RA use was linked with reduced perioperative and long-term surgical complications in patients undergoing thoracic and/or lumbar fusions for degenerative spine disease, particularly in those with BMI ≥25. This risk reduction may be attributed to weight loss and/or the systemic metabolic, inflammatory, and vascular benefits of these medications.