Do Preoperative Glucagon-Like Peptide-1 Receptor Agonists Influence Lumbar Fusion Outcomes? A Systematic Review and Meta-Analysis

Abstract

Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in patients with obesity and type 2 diabetes, but lumbar fusion-specific associations with postoperative outcomes remain uncertain. Objective To evaluate the association between preoperative GLP-1RA exposure and surgical and postoperative outcomes in adults undergoing lumbar fusion. Methods PubMed, Embase, and the Cochrane Library were searched from inception through 14 May 2026. Comparative studies of adults undergoing lumbar fusion with and without preoperative GLP-1RA exposure were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). Random-effects meta-analyses generated odds ratios with 95% confidence intervals. The protocol was prospectively registered in PROSPERO (CRD420261414637). Results Seven retrospective cohorts involving 28,525 patients were included; 6 used propensity score matching or another matching strategy. No statistically significant associations were observed between preoperative GLP-1RA exposure and reoperation or revision (OR: 0.74, 95% CI: 0.44–1.24; P = 0.25), postoperative infection (OR: 0.83, 95% CI: 0.68–1.00; P = 0.05), wound complications (OR: 0.86, 95% CI: 0.65–1.12; P = 0.26), or postoperative respiratory complications (OR: 1.08, 95% CI: 0.63–1.84; P = 0.69). Deep vein thrombosis, pulmonary embolism, and unplanned emergency department visits also did not differ significantly. All included studies were observational and predominantly used large administrative data sources. Conclusions Across the evaluated outcomes, the available observational evidence did not identify a signal of increased postoperative risk associated with preoperative GLP-1RA exposure after lumbar fusion. Prospective studies with standardized exposure definitions and perioperative management protocols are warranted to confirm these findings and better define their clinical implications. Clinical Relevance Current observational evidence does not establish preoperative GLP-1RA exposure alone as an independent risk factor for adverse outcomes after lumbar fusion. Level of Evidence 3.