Can glucagon-like peptide-1 receptor agonists affect outcomes after spine surgery? A systematic review and meta-analysis.

PURPOSE: To evaluate the association between glucagon-like peptide-1 receptor agonist (GLP-1RA) use and perioperative, postoperative and fusion-related outcomes following spine surgery.

METHODS

A systematic search of PubMed/ MEDLINE, Scopus, Web of Science, and the Cochrane Library was conducted from inception through December 2025 in accordance with PRISMA 2020 guidelines. Comparative studies evaluating outcomes of spine surgery in patients exposed to GLP-1RAs versus non-users were included. Random-effects meta-analyses were performed for perioperative outcomes, medical and surgical complications, reoperation and fusion-related outcomes. Subgroup analyses were conducted based on diabetes status, fusion levels and duration of follow-up.

RESULTS

Twenty comparative studies with 546,668 patients were included in the analysis. GLP-1RA use was not associated with significant differences in perioperative or postoperative outcomes, including transfusion [log odds ratio (OR)=-0.25,95% CI:-0.67,0.17), operative time [mean difference (MD)=-5.3 min,95% CI:-23.9,13.3)], length of stay (MD=-0.19days,95% CI:-1.35,0.96), surgical site infection (logOR = 0.29,95% CI:-0.08,0.66), venous thromboembolism (logOR = 0.19,95% CI:-0.25,0.63), readmission (logOR = 0.31,95% CI:-0.07,0.69), reoperation (logOR = 0.12,95% CI:-0.17,0.42), or implant failure. In contrast, GLP-1RA use was associated with higher fusion success (logOR = 0.42,95% CI:0.33,0.51;p < 0.001), consistent across follow-up intervals.

CONCLUSION

In the available observational literature, GLP-1RA use is not associated with increased perioperative complications following spine surgery and may be related to improved fusion outcomes. These findings provide reassurance regarding perioperative safety and suggest a potential long-term benefit in arthrodesis, although prospective studies are needed to confirm causality and define optimal perioperative management strategies.

LEVEL OF EVIDENCE: III.