Patients on Long-Term Preoperative Glucagon-Like Peptide-1 Receptor Agonist Therapy Show Significant Reductions in Postoperative Complications After Elective Laminectomy in Overweight Adults: A Propensity-Matched Study

Abstract

Background: Patients with obesity undergoing spine surgery are at increased risk for postoperative complications. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for diabetes and weight management, but their perioperative impact in spine procedures is not well defined. This study evaluated whether long-term preoperative GLP-1 RA therapy is associated with improved postoperative outcomes after elective laminectomy in overweight adults. Methods: A retrospective cohort study was performed using the TriNetX research network across 72 US health systems. Overweight or obese adults undergoing elective cervical, thoracic, or lumbar laminectomy were divided into GLP-1 RA users (≥6 months of continuous preoperative therapy) and nonusers. Propensity score matching (1:1) was performed across 33 demographic and clinical variables. Outcomes assessed at 90 days and 1 year included sepsis, acute kidney injury, deep vein thrombosis, myocardial infarction, pneumonia, stroke, wound dehiscence, surgical site infection, postlaminectomy syndrome, and all-cause mortality. Results: Matched cohorts included 5680 patients per group. GLP-1 RA therapy was associated with significantly lower odds of sepsis (OR 0.38 at 90 days; 0.52 at 1 year), deep vein thrombosis (0.26; 0.41), wound dehiscence (0.38; 0.47), surgical site infection (0.37; 0.43), and mortality (0.30; 0.48; all P < 0.001). Acute kidney injury showed a borderline reduction (OR 0.80; P = 0.046). No significant differences were observed for myocardial infarction, pneumonia, or stroke. Conclusions: Long-term preoperative GLP-1 RA therapy was associated with reduced postoperative infectious, thrombotic, and wound-related complications, as well as lower mortality, following elective laminectomy in overweight adults. These findings support the potential role of GLP-1 RA use in preoperative optimization strategies for high-risk surgical populations. Clinical Relevance: Identifying modifiable risk factors is essential for improving outcomes in overweight or obese patients undergoing spine surgery. This study suggests that GLP-1 RAs may serve as a practical and effective preoperative optimization tool to reduce complications and enhance postoperative recovery.Level of Evidence: 3.