Reduced Complications and Improved Survival With Postoperative GLP-1 Receptor Agonist Use Following Lumbar Arthrodesis

Study Design Retrospective propensity-score-matched cohort study. Objectives To evaluate whether postoperative glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is associated with fewer complications, lower pseudarthrosis, and improved survival after lumbar fusion in adults aged 50 years and older. Methods The TriNetX Global Collaborative Network was queried to identify adults ≥50 years who underwent lumbar arthrodesis (2010-2025). GLP-1 RA exposure was defined as an active prescription within 1 to 90 days postoperatively. The comparison group consisted of patients without a GLP-1 RA prescription during this window. Propensity score matching adjusted for demographics, BMI, hemoglobin A1c, preoperative GLP-1 RA use, and comorbidities. Outcomes: 90-day and 1-year infectious, pulmonary, and thromboembolic complications, 1-year pseudarthrosis, and 1-year mortality rates. Survival was assessed with Kaplan Meier and Cox regression. Results Among 169 286 patients who underwent lumbar arthrodesis, 1844 had postoperative GLP-1 RA use and 167 442 did not. After matching, 1816 patients remained in each cohort. Postoperative GLP-1 RA use was associated with lower 90-day pneumonia (Risk Ratio RR 0.51), surgical site infection (RR 0.58), sepsis (RR 0.64), urinary tract infection (RR 0.56), wound dehiscence (RR 0.46), and venous thromboembolism (RR 0.54) (all P < 0.05), and 1-year lower hazard of death (HR 0.38; P = 0.018). Conclusion In this large propensity-score-matched cohort, postoperative GLP-1 RA use was associated with fewer early infectious, pulmonary, wound, and thromboembolic complications and improved 1-year survival after lumbar spinal fusion.