Perioperative Glucagon-Like Peptide-1 Agonist Use and Rates of Pseudarthrosis after Single-Level Lumbar Fusion: A Large Retrospective Cohort Study

BACKGROUND AND OBJECTIVE:Pseudarthrosis is a common surgical complication after arthrodesis and is associated with poor clinical outcomes. The association between glucagon-like peptide-1 (GLP-1) agonist use and pseudarthrosis is yet to be explored. This study aims to examine the association of GLP-1 agonists with rates of pseudarthrosis in patients undergoing single-level lumbar fusion.METHODS:This national multicenter cohort study used data spanning from June 19, 2010, to June 19, 2024, from the global health network TriNetX. One-To-one propensity score matching for age, sex, race, comorbidities, body mass index, and A1c was conducted to balance cohorts. The rates of pseudarthrosis were then assessed within the 6-month, 1-year, and 2-year postsurgical follow-up periods.RESULTS:A total of 37 147 patients who underwent single-level lumbar fusion (mean [SD] age, 59.3 [13.5] years; 47.7% men and 52.3% women) were enrolled in the study. Among these, 712 individuals (1.9%) were identified as GLP-1 agonist users. After propensity score matching, there were 709 patients in each cohort. Patients who took a GLP-1 agonist had lower odds of developing pseudarthrosis 6 months [odds ratio (OR): 0.70, 95% CI: 0.51-0.96], 1 year [OR: 0.68, 95% CI: 0.50-0.91], and 2 years (OR: 0.68, 95% CI: 0.50-0.91) after a posterior lumbar interbody fusion/transforaminal lumbar interbody fusion procedure.CONCLUSION:In this cohort study, patients who were prescribed GLP-1 agonists in the perioperative period had reduced rates of pseudarthrosis compared with patients without GLP-1 agonist prescriptions. These findings suggest a potential therapeutic benefit of GLP-1 agonists in enhancing spinal fusion outcomes and warrant further prospective studies to confirm these results and explore the underlying mechanisms.