Glucagon-like peptide-1 receptor agonist use prior to spinal surgery results in reduced postoperative length of stay: A propensity-score matched analysis.

Background: While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated benefits in reducing complications following total knee and hip arthroplasty, their effects in spinal surgery remain unclear. Prior studies have reported mixed results across select spinal fusion procedures, and the impact of GLP-1 RAs on perioperative outcomes has not been well-defined. This study evaluates the association between preoperative GLP-1 RA use and key perioperative outcomes in spinal surgery. Methods: We conducted a retrospective, propensity score-matched analysis of adult patients (≥18 years) undergoing spinal decompression and/or fusion at an urban academic spine service over the past 5 years. Patients prescribed a GLP-1 RA preoperatively comprised the exposure cohort. A 1:4 nearest-neighbor propensity score matching algorithm was then used to identify comparable controls without GLP-1 RA use, based on age, sex, body mass index (BMI), primary procedure code, comorbidities (diabetes, hypertension, hyperlipidemia, heart disease, smoking status, kidney disease, and anxiety), and the use of prevalent diabetic medications (insulin, metformin, sulfonylureas, and SGLT-2 inhibitors). Primary outcomes included length of stay (LOS), operating room (OPR) time, 90-day reoperation, 90-day readmission, and nonroutine discharge. Binary outcomes were assessed using multivariate logistic regression, while the Mann-Whitney U test was used for continuous variables. Results: The final matched cohort included 1385 patients (GLP-1 RA: Conclusions: Preoperative GLP-1 RA use was associated with a statistically significant reduction in postoperative LOS among patients undergoing spinal decompression and/or fusion. Further prospective, multi-institutional studies are warranted to validate these findings and to determine whether this reduction translates into clinically and financially meaningful benefits, including improved long-term outcomes.