Glucagon-like peptide-1 receptor agonist use and perioperative outcomes after anterior cervical discectomy and fusion: a propensity-matched cohort study.

BACKGROUND CONTEXT: Glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as a powerful treatment adjunct for type-2 diabetes mellitus (T2DM) and obesity by delaying gastric emptying and promoting early satiety. Previous studies have shown decreased complications associated with GLP-1 agonists after total hip and knee arthroplasty; however, the effects of GLP-1 agonists on outcomes following anterior cervical discectomy and fusion (ACDF) are not well known.

PURPOSE: This study aimed to compare the risk of complications after ACDF in patients with T2DM and obesity (body mass index >30) who were on GLP-1 agonists with comparable patients who were not on these medications. We hypothesized that these medications reduce overall complications when compared to a matched cohort of diabetic and/or obese patients, but may place patients who undergo anterior cervical surgery at increased risk of aspiration due to the delayed gastric emptying.

STUDY DESIGN/

SETTING

Retrospective cohort study.

PATIENT SAMPLE: Adult patients with T2DM and/or obesity undergoing single or 2-level ACDF between 2015 and 2022.

OUTCOME MEASURES: Outcomes of the study included the incidence of 90-day and 1-year postoperative complications, including surgical site infections, wound dehiscence, hematoma, dysphagia, pulmonary aspiration, deep vein thrombosis or pulmonary embolism (DVT/PE), acute kidney injury, sepsis, hospital readmissions, extended hospital length of stay (≥3 days), and pseudarthrosis or nonunion.

METHODS

Adult patients with T2DM and/or obesity undergoing single or 2-level primary ACDF between 2015 and 2022 were reviewed utilizing an administrative claims database. Patients who had concurrent posterior decompression and fusion procedures were excluded. Propensity score matching was employed at a 1:1 ratio to match patients using GLP-1 agonists 6 months before and after surgery (treatment) to those who did not (control). Patients were matched on age, sex, Elixhauser comorbidity index, insulin-dependence and diabetic complications, presence of other diabetic medications, morbid obesity (body mass index >40), and active smoking status. Multivariable logistic regressions were performed to examine 90-day and 1-year outcomes between groups.

RESULTS

In total, 20,941 patients with T2DM and/or obesity were queried from the database. 1,598 patients were included in both the treatment group and control group after propensity-score matching. There were no differences in rates of postoperative pulmonary aspiration in patients utilizing GLP-1 agonists compared to those who were not (0.81% vs 1.25%, p=.39). There were decreased rates of 90-day DVT/PE (0.44% vs 0.94%, p=.04), and acute kidney injury (0.94% vs 1.69%, p=.04) in the treatment group when compared to the control group. GLP-1 agonist use was associated with decreased rates of extended hospital stays (15.96% vs 18.65%, p=.04). At 1 year after ACDF, there were no differences in rates of DVT/PE (1.56% vs 2.00%, p=.36) or pseudarthrosis (2.82% vs 3.25%, p=.50).

CONCLUSIONS

In this study, GLP-1 agonists have shown favorable outcomes without increasing the risk of aspiration in patients who undergo a single or 2-level ACDF. In addition to reducing postoperative medical complications, the medications also showed no increased risk of postoperative pulmonary aspiration or 1-year pseudarthrosis. Overall, while GLP-1 agonists provide benefits including increased glycemic control and weight loss, more data are needed to delineate the true effect of GLP-1 agonists on clinical outcomes following ACDF.