GLP-1 receptor agonists in elective spine surgery: a systematic review of fusion outcomes, perioperative safety, and procedure-specific risk
- Design
- Systematic review · Mixed outcome
- Match to healthy normal-weight adults aged 55–75
- Population unclearUNKNOWN: adults having elective spine surgery; the age, BMI and diabetes status of included patients are not reported in the abstract.
- Could weight loss explain it?
- PossiblyPossibly: the authors note that longitudinal BMI or weight change was incompletely characterized across the included studies, so weight change is not separated from a drug effect.
- Study tier
- Not ratedNOT_RATED: a qualitative systematic review with no pooled estimate or new primary data, built mostly on retrospective cohorts; the alternative is LOW.
- Assessment
- Version 3 · Two reviewers differed; settled by a recorded ruling · Oct 19, 2026
Study facts come from the paper. Population match, weight-loss explanation and study tier are our judgments, made against the reference group of healthy normal-weight adults aged 55–75.
This systematic review gathered twenty-three studies, mostly retrospective database analyses, of adults exposed to GLP-1 drugs around elective spine surgery. Results depended on the operation: lower-back (lumbar) fusion studies were generally linked to neutral or favourable outcomes, though some transforaminal lumbar interbody fusion cohorts showed adverse associations, and neck (cervical) fusion results were mixed. The findings are associations from observational studies, not proof that the drugs help or harm.
01Findings
What the study reported
- Drugs
- Glp-1 receptor agonists
- Dose
- various
- Comparator
- not reported in abstract
- Primary outcome
- fusion outcomes, perioperative complications, surgical site infection, readmission, length of stay and costs after elective spine surgery
- Effect
- no pooled estimate; lumbar fusion studies mostly favourable or neutral, some transforaminal lumbar interbody fusion cohorts adverse; cervical results heterogeneous, with posterior cervical fusion conflicting; no included study reported postoperative pancreatitis
- 95% confidence interval
- not reported in abstract
- Follow-up
- Not stated
- Adverse events
- Some transforaminal lumbar interbody fusion and posterior cervical fusion cohorts reported adverse or conflicting associations; gastrointestinal safety data were sparse and no included study reported postoperative pancreatitis.
- Limitations
- The evidence is predominantly observational and should be read as association; preoperative treatment duration and BMI or weight change were incompletely characterized, and the synthesis is qualitative without pooled estimates.
Who was studied
- Obesity status
- not reported in abstract
- Diabetes status
- not reported in abstract
- Cvd status
- not reported in abstract
- Ckd status
- not reported in abstract
- Baseline condition
- elective spine surgery
- Inclusion exclusion
- comparative studies of adults having spine surgery with documented preoperative or perioperative GLP-1 RA exposure
Study quality details
- Study design
- Systematic review
- Sample size
- not extracted
- Randomization
- n/a
- Blinding
- n/a
- Comparator
- not reported in abstract
- Follow up duration
- not stated
- Outcome type
- mixed
- Replication
- not assessed
- Consistency with other evidence
- not assessed
- Population applicability
- UNKNOWN
- Statistical precision
- no pooled estimate or CI reported; qualitative synthesis of twenty-three studies
- Risk of bias
- not assessed
- Funding conflicts
- unclear
- Peer review status
- yes
02Funding
Funding and conflicts
- Funding
- not reported in abstract
- Industry funded
- Unclear
- Manufacturer
- not stated in source
- Sponsor role
- not reported in abstract
- Author conflicts
- The authors certify no conflict of interest with any financial organization regarding the material discussed.
- Independent replication
- unknown
Funding is shown on every study and never used to score it.
04Source
The source, as retrieved
Abstract
[BACKGROUND] Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used in patients with obesity and type 2 diabetes mellitus undergoing elective spine surgery. Although these agents may improve metabolic risk profiles, their associations with spinal fusion, perioperative complications, and procedure-specific outcomes remain incompletely defined. [METHODS] We conducted a systematic review and qualitative synthesis of comparative clinical studies evaluating adults undergoing spine surgery with documented preoperative or perioperative GLP-1 RA exposure. Eligible studies assessed fusion-related outcomes, perioperative medical complications, surgical site infection, readmission, length of stay, healthcare utilization or costs, and musculoskeletal outcomes. The review was conducted in accordance with PRISMA 2020 principles, with eligibility criteria defined using a PICOS framework. [RESULTS] Twenty-three studies were included, consisting predominantly of retrospective cohort studies and propensity-matched database analyses. Lumbar fusion studies generally reported favorable or neutral associations between GLP-1 RA exposure and pseudarthrosis, infection, readmission, and healthcare utilization, although some transforaminal lumbar interbody fusion cohorts reported adverse associations. Cervical fusion outcomes were more heterogeneous and appeared to vary by surgical approach. Anterior cervical fusion studies generally reported neutral or favorable outcomes, whereas posterior cervical fusion studies yielded conflicting findings. Gastrointestinal safety data were sparse, no included study reported postoperative pancreatitis, and preoperative treatment duration and longitudinal BMI or weight change were incompletely characterized. [CONCLUSIONS] Current evidence suggests that GLP-1 RA exposure is associated with procedure-specific differences in outcomes after elective spine surgery. Because the available evidence is predominantly observational, these findings should be interpreted as associations rather than evidence of direct causal benefit or harm. Perioperative GLP-1 RA management should be individualized according to surgical procedure, metabolic status, gastrointestinal symptoms, renal and hydration risk, and nutritional or sarcopenia-related vulnerability.