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.
Introduction
Recovery after lumbar fusion is influenced not only by surgical indication and technique but also by the metabolic conditions commonly present among candidates for spine surgery. Obesity and type 2 diabetes are particularly relevant because both are associated with higher risks of postoperative infection, venous thromboembolism, medical complications, wound complications, and readmission.1,2 Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and related incretin-based therapies have become increasingly central to the management of these conditions. Randomized trials have demonstrated substantial weight loss with semaglutide and tirzepatide and reductions in major adverse cardiovascular events with semaglutide in selected patients with overweight or obesity.3–5 As the use of these therapies expands among patients considered for elective lumbar fusion, determining whether preoperative GLP-1RA exposure is associated with surgical and postoperative outcomes has become an increasingly important question in spine practice.
Lumbar fusion is performed for degenerative disorders such as spondylolisthesis, spinal stenosis with instability, degenerative disc disease, and deformity. In a national analysis from the United States, the annual volume of elective lumbar fusions for degenerative disease increased from 122,679 procedures in 2004 to 199,140 in 2015, accompanied by substantial growth in hospital costs.6 Although lumbar fusion can improve pain and function in appropriately selected patients, postoperative morbidity remains clinically relevant, particularly in metabolically complex individuals.1,2,7 Infection, impaired wound healing, thromboembolic events, respiratory complications, unplanned emergency department visits, and reoperation or revision may directly affect recovery, resource use, and perioperative decision-making.
Despite growing interest, the available evidence on GLP-1RAs in spine surgery remains recent, predominantly observational, and methodologically heterogeneous. Previous systematic reviews pooled cervical, lumbar, and mixed spine procedures despite differences in surgical indications, operative approaches, baseline complication risks, and clinically relevant outcomes, thereby limiting direct inference for patients undergoing lumbar fusion.8,9 Furthermore, lumbar fusion studies differ in the metabolic populations evaluated, GLP-1RA agents and exposure definitions, fusion techniques, follow-up periods, and methods of outcome ascertainment.10–12 These differences may obscure whether the available lumbar-specific evidence demonstrates a consistent association between preoperative GLP-1RA exposure and outcomes directly relevant to this procedure. Therefore, this systematic review and meta-analysis aimed to evaluate the association between preoperative GLP-1RA exposure and surgical and postoperative outcomes specifically in adults undergoing lumbar fusion.
Methods
Protocol and Reporting
This systematic review and meta-analysis was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions13 and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and Meta-analysis of Observational Studies in Epidemiology recommendations.14,15 The protocol was prospectively registered in PROSPERO (CRD420261414637). Because only aggregate data from previously published studies were analyzed, institutional review board approval and informed consent were not required.
Search Strategy
PubMed (MEDLINE), Embase, and the Cochrane Library were searched from inception through 14 May 2026. No language, publication-date, or study-design restrictions were applied. Search concepts covered the lumbar and lumbosacral spine, lumbar fusion procedures and related approaches, adult spinal deformity, GLP-1RAs, and specific agents, including semaglutide, liraglutide, dulaglutide, exenatide, lixisenatide, and tirzepatide. Reference lists of included reports and relevant reviews were screened manually. The full electronic search strategy is provided in Supplementary Material 1.
Eligibility Criteria
Eligible studies were randomized trials or analytical observational studies that compared adults with preoperative GLP-1RA exposure, according to each study’s reported exposure window, with nonusers undergoing lumbar fusion. Eligible procedures included anterior, posterior, lateral, or combined lumbar arthrodesis; transforaminal lumbar interbody fusion; posterior lumbar interbody fusion; anterior lumbar interbody fusion; posterolateral fusion; and fusion with or without associated decompression. Mixed cohorts were eligible only when lumbar fusion-specific data were separately extractable and at least 1 prespecified postoperative outcome was reported.
We excluded noncomparative studies, case reports and case series, reviews, editorials, letters, comments, conference abstracts without full-text publication, animal or in vitro studies, studies limited to nonlumbar procedures, non–GLP-1RA weight-loss interventions without a separable GLP-1RA group, and studies lacking an extractable prespecified outcome.
Study Selection and Data Extraction
All retrieved records were managed in Rayyan for duplicate identification and screening.16 Two reviewers independently screened titles and abstracts, assessed full texts, and extracted data using a structured Microsoft Excel spreadsheet. Disagreements were resolved by consensus or, when necessary, by a third reviewer. Extracted variables included publication year, data source, study period, sample size, demographic and clinical characteristics, GLP-1RA agent, exposure definition and window, comparator definition, fusion procedure, matching or adjustment method, outcomes, and follow-up duration.
Assessment of Potential Cohort Overlap
Potential patient overlap was evaluated rigorously and conservatively, study by study and outcome by outcome, before each quantitative synthesis. Reports were compared according to the database and subset, enrollment period, eligibility criteria, metabolic population, lumbar fusion procedure, number of fused levels, GLP-1RA exposure definition and window, matching strategy, outcome definition, and follow-up interval. The use of the same administrative database alone was not considered sufficient to establish direct overlap when clear and verifiable differences existed in the populations, procedures, or study periods. Whenever any plausible possibility of shared patients remained for the same outcome and follow-up interval, the estimates were not included together in the same forest plot. In such cases, the report with the most clinically relevant population, clearest exposure and outcome definitions, most appropriate adjustment, and most complete reporting was retained for quantitative synthesis; the other report remained eligible for qualitative synthesis when relevant.
Outcomes and Definitions
The primary surgical outcome was reoperation or revision after lumbar fusion. Other prespecified outcomes were postoperative infection, wound complications, deep vein thrombosis, pulmonary embolism, postoperative respiratory complications, and unplanned emergency department visits. Renal outcomes were not included in quantitative synthesis because the original studies used nonequivalent definitions, including acute kidney injury and renal failure. For reoperation or revision, the longest available follow-up was prioritized; for perioperative and short-term outcomes, the earliest available postoperative follow-up was prioritized.
Outcome definitions and ascertainment methods were retained as reported by the original studies. Outcomes were combined only when their definitions represented the same clinical event and were assessed over comparable postoperative periods; otherwise, they were presented separately or narratively. Postoperative infection included surgical site infection and other procedure-related postoperative infectious outcomes when defined as such by the original studies. Wound complications included dehiscence, altered wound healing, wound complication, or wound abnormality according to each study’s definition. Postoperative respiratory complications included pneumonia and broader respiratory complications reported during comparable postoperative periods. Deep vein thrombosis and pulmonary embolism were evaluated separately.
Preoperative GLP-1RA exposure was defined according to the original study and could include semaglutide alone or GLP-1RAs as a class. The agent, exposure definition, and identification window were extracted for each study. A prescription or recorded use was considered evidence of preoperative exposure but did not confirm adherence, effective treatment duration, or perioperative continuation.
Risk of Bias Assessment
Risk of bias was assessed independently by 2 reviewers using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool.17 Prespecified confounders included age, sex, body mass index or obesity, diabetes status, smoking, comorbidity burden, surgical indication, fusion procedure and approach, number of fused levels when available, and baseline metabolic risk factors. The 7 ROBINS-I domains were assessed, and overall judgments followed the recommended algorithm. Disagreements were resolved by consensus or third-reviewer adjudication.
Statistical Methods
Meta-analyses were performed in Review Manager Web.18 For dichotomous outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were the summary measure. Event counts and total sample sizes were extracted for each group. When propensity score matching or another matching method was reported, data from matched cohorts were preferentially used. When only percentages were available, event counts were derived from the corresponding group size and reported percentage.
Random-effects models were used because clinical and methodological heterogeneity was expected. Between-study variance was estimated with restricted maximum likelihood. Hartung-Knapp-Sidik-Jonkman confidence intervals were used when τ² was greater than zero and more than 2 studies contributed to an analysis; Wald-type confidence intervals were used when τ² was zero.19 Heterogeneity was assessed with Cochran’s Q, I², and τ²; a Q test P value < 0.10 or I² > 25% was considered suggestive of relevant heterogeneity.20 Two-sided P values < 0.05 were considered statistically significant. Funnel plots and regression-based tests for small-study effects were not performed because fewer than 10 studies contributed to each synthesis.
Results
Study Selection
Database searching identified 260 records: 49 from PubMed, 202 from Embase, and 9 from the Cochrane Library. After removal of 104 duplicates, 156 records underwent title and abstract screening; 139 were excluded. Seventeen full texts were assessed, and 10 were excluded because of wrong population (n = 3), conference abstracts without full-text publication (n = 5), or overlapping populations (n = 2). Seven studies were included in the systematic review and meta-analysis (Figure 1).
PRISMA 2020 flow diagram showing study identification, screening, eligibility assessment, and inclusion.
Study Characteristics and GLP-1RA Exposure
The 7 included studies were retrospective cohorts conducted in the United States: 5 used PearlDiver/Mariner, 1 used the TriNetX Research Network, and 1 was an institutional cohort.11,21–26 Across the extracted analytical cohorts, 28,525 patients undergoing lumbar fusion were evaluated; 6 studies used propensity score matching or another matching strategy. Populations included patients with diabetes, individuals with obesity without diabetes, and patients using GLP-1RAs exclusively for weight loss. Patients underwent different lumbar fusion techniques and had varying follow-up periods of 3 to 24 months.
Five studies evaluated semaglutide exclusively, whereas Ghali et al evaluated GLP-1RAs as a class and Baidya et al included semaglutide, liraglutide, dulaglutide, and exenatide. In both studies by Khalid et al, semaglutide exposure was identified from prescription records, with additional analyses stratified by duration of less than 9 months or at least 9 months. Ghali et al classified patients as exposed when they received a GLP-1RA within 3 months before surgery. Ng et al, in the single-level lumbar fusion study, included patients receiving semaglutide at the time of surgery, although the preoperative duration was unavailable. In the anterior lumbar interbody fusion study, Ng et al required an active prescription and evidence of continuous semaglutide use for at least 1 year before surgery. Seddio et al defined exposure as recorded use of a semaglutide-containing medication during the year before fusion. Baidya et al identified GLP-1RA use within 90 days before surgery and confirmed active use by manual chart review.11,21–26 These definitions represented recorded preoperative exposure and did not necessarily confirm adherence, uninterrupted treatment, or perioperative continuation. Full study and exposure characteristics are presented in the Table.
Baseline characteristics of included studies.
Five studies originated from PearlDiver/Mariner or reported subsets of that database but differed in eligibility criteria, metabolic populations, enrollment periods, fusion procedures, and follow-up windows. The study- and outcome-specific assessment did not identify estimates with a plausible possibility of direct overlap that were included together in the same pooled effect.
Postoperative Outcomes
Reoperation or Revision
Three cohorts evaluated reoperation or revision. GLP-1RA exposure was not associated with a statistically significant difference vs nonuse (OR: 0.74, 95% CI: 0.44–1.24; P = 0.25; I² = 0%; Figure 2).
Forest plot comparing reoperation or revision after lumbar fusion between patients with and without preoperative glucagon-like peptide-1 receptor agonist (GLP-1RA) exposure.
Postoperative Infection
Four cohorts evaluated postoperative infection, including surgical site infection where specifically reported, with no statistically significant difference (OR: 0.83, 95% CI: 0.68–1.00; P = 0.05; I² = 0%; Figure 3).
Forest plot comparing postoperative infection after lumbar fusion between patients with and without preoperative glucagon-like peptide-1 receptor agonist (GLP-1RA) exposure.
Wound Complications
Four cohorts evaluated wound complications, also without a significant difference (OR: 0.86, 95% CI: 0.65–1.12; P = 0.26; I² = 0%; Figure 4).
Forest plot comparing wound complications after lumbar fusion between patients with and without preoperative glucagon-like peptide-1 receptor agonist (GLP-1RA) exposure.
Postoperative Respiratory Complications
Four cohorts assessed postoperative respiratory complications, including pneumonia where specifically reported; the association was not statistically significant (OR: 1.08, 95% CI: 0.63–1.84; P = 0.69; I² = 1%; Figure 5).
Forest plot comparing postoperative respiratory complications after lumbar fusion between patients with and without preoperative glucagon-like peptide-1 receptor agonist (GLP-1RA) exposure.
Additional Outcomes
Additional outcomes did not differ significantly between groups: deep vein thrombosis (OR: 0.93, 95% CI: 0.65–1.35; P = 0.71; I² = 0%), pulmonary embolism (OR: 0.51, 95% CI: 0.01–22.48; P = 0.52; I² = 49%), and unplanned emergency department visit (OR: 0.52, 95% CI: 0.17–1.59; P = 0.16; I² = 91%). Forest plots are provided in Supplementary Figures S1-S3. Renal outcomes were reported with heterogeneous definitions and were not quantitatively combined.
Risk of Bias
Five studies were judged at low overall risk of bias and 2 at moderate risk. The most frequent domain-level concern was confounding, rated moderate in 6 studies. Additional moderate concerns involved missing data in 1 study and outcome measurement in 1 study. No study was judged at serious or critical overall risk. Study-level and domain-level ROBINS-I assessments are presented in Supplementary Figures S4 and S5, and detailed judgments are provided in Supplementary Table S1, all of which are provided in the Supplementary Material 1 file.
Discussion
In this lumbar fusion-specific systematic review and meta-analysis, preoperative GLP-1RA exposure was not associated with statistically significant differences in reoperation or revision, postoperative infection, wound complications, postoperative respiratory complications, deep vein thrombosis, pulmonary embolism, or unplanned emergency department visits. These findings do not demonstrate a consistent association between recorded preoperative exposure and worse postoperative outcomes, but they should not be interpreted as proof of equivalence, a protective effect, or definitive safety. Given the retrospective observational design of all included studies, causal inferences cannot be established.
The principal contribution of this review is its focus on lumbar fusion. Previous reviews combined cervical, lumbar, and mixed spine procedures with different indications, approaches, exposure definitions, and outcome windows.8,9 By restricting eligibility to lumbar fusion and extracting lumbar-specific data from mixed reports only when separately available, this review provides a more directly applicable synthesis for spine surgeons. Clinically, the available evidence does not identify preoperative GLP-1RA exposure alone as a factor associated with increased reoperation, postoperative infection, wound complications, or postoperative respiratory complications after lumbar fusion. However, the included studies did not directly compare perioperative continuation with discontinuation, and the available exposure definitions generally did not establish the exact timing of the last dose relative to surgery.11,21–26 Accordingly, the present findings primarily reflect outcomes among patients classified as preoperative GLP-1RA users rather than the direct pharmacologic effects of active GLP-1RA exposure at the time of surgery. These results should therefore not be used to determine whether GLP-1RAs should be maintained or withheld perioperatively.
The absence of statistically significant associations does not establish that GLP-1RAs have no effect across all agents, doses, indications, exposure windows, or fusion techniques. Clinical heterogeneity was particularly relevant in the definition of preoperative exposure, which ranged from active use at the time of surgery or chart-confirmed use within 90 days to recorded use within the preceding year, with additional variation in treatment duration and GLP-1RA agents.11,21–26 These definitions may capture clinically distinct exposure states, and broad exposure windows may dilute associations related to recent or active GLP-1RA exposure by grouping patients with substantially different timing of medication use within the same exposed category. Accordingly, the pooled estimates should be interpreted as associations with recorded preoperative GLP-1RA exposure across heterogeneous lumbar fusion populations rather than effects of a standardized perioperative GLP-1RA regimen.
This review included only 7 studies, all retrospective and predominantly derived from large administrative databases. Although these sources permit evaluation of large populations, they remain susceptible to coding inaccuracies, residual confounding, and incomplete clinical detail regarding medication exposure, surgical complexity, perioperative management, and outcome ascertainment. In particular, prescription or medication records do not confirm adherence, treatment duration, the exact timing of the last dose, or whether GLP-1RA therapy was continued or withheld perioperatively. The small number of studies contributing to several syntheses, together with the low frequency of some events, limited precision for uncommon outcomes, and may have reduced the ability to detect small but clinically relevant differences between groups. The limited number of studies also constrained exploration of heterogeneity and assessment of publication bias. Although the absence of patient-level identifiers prevents absolute exclusion of residual overlap, this possibility is considered extremely unlikely after the conservative study- and outcome-specific assessment; whenever any plausible possibility of shared patients existed, the estimates were not pooled together.
Strengths include the procedure-specific focus, prospective registration, independent screening and extraction, preferential use of matched cohorts, assessment of outcome comparability before pooling, and explicit management of potentially overlapping populations. Together, these methods improve transparency while preserving a clinically focused interpretation of the available evidence.
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.
Supplementary material
Supplementary Material 1.
Footnotes
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests The authors report no conflicts of interest in this work.
Ethics Statement This systematic review and meta-analysis analyzed aggregate data from previously published reports. Institutional review board approval and informed consent were not required.
- This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2026 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.
References
- 1.↵Jackson KL , Devine JG . The effects of obesity on spine surgery: a systematic review of the literature. Global Spine J. 2016;6(4):394–400. 10.1055/s-0035-1570750
- 2.↵Shah AA , Devana SK , Lee C , et al . Prediction of major complications and readmission after lumbar spinal fusion: a machine learning-driven approach. World Neurosurg. 2021;152:e227–e234. 10.1016/j.wneu.2021.05.080
- 3.↵Wilding JPH , Batterham RL , Calanna S , et al . Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989–1002. 10.1056/NEJMoa2032183
- 4.↵Jastreboff AM , Aronne LJ , Ahmad NN , et al . Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205–216. 10.1056/NEJMoa2206038
- 5.↵Lincoff AM , Brown-Frandsen K , Colhoun HM , et al . Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221–2232. 10.1056/NEJMoa2307563
- 6.↵Martin BI , Mirza SK , Spina N , Spiker WR , Lawrence B , Brodke DS . Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the united states, 2004 to 2015. Spine (Phila Pa 1976). 2019;44(5):369–376. 10.1097/BRS.0000000000002822
- 7.↵Weinstein JN , Lurie JD , Tosteson TD , et al . Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am. 2009;91(6):1295–1304. 10.2106/JBJS.H.00913
- 8.↵Younus I , Garcia de Oliveira R , Fujii T . Are GLP-1 receptor agonists safe in spine surgery? A systematic review. Spine (Phila Pa 1976). 1976;50(21):1529–1537. 10.1097/BRS.0000000000005466
- 9.↵Ononogbu-Uche FC , Toussaint F , Saleh AW , et al . Do GLP-1 agonists affect perioperative risk in spine surgery? A systematic review and meta-analysis. N Am Spine Soc J. 2026;25:100835. 10.1016/j.xnsj.2025.100835
- 10.↵Kesaria AA , Marzook FA , Glover JM , Alijanipour P . Association between preoperative GLP-1 receptor analog use and postoperative complications and mortality following lumbar fusion surgery. Global Spine J. 2026;16(4):1889–1897. 10.1177/21925682251391693
- 11.↵Ng MK , Mastrokostas PG , Rodriguez AN , et al . Semaglutide use before single-level lumbar fusion associated with fewer readmissions and 90-day costs. J Craniovertebr Junction Spine. 2025;16(4):401–407. 10.4103/jcvjs.jcvjs_156_25
- 12.↵Chang Y , Lin HM , Chi KY , Song J , Atwan H . The impact of semaglutide on fusion rates following posterior lumbar fusion surgery in patients with type 2 diabetes. Int J Surg. 2025;111(7):4898–4900. 10.1097/JS9.0000000000002492
- 13.↵Higgins JPT , Thomas J , Chandler J , et al , eds. cochrane handbook for systematic reviews of interventions . Cochrane Handbook for Systematic Reviews of Interventions. Version 6.5. Cochrane; 2024.
- 14.
- 15.↵Stroup DF , Berlin JA , Morton SC , et al . Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283:2008–2012. 10.1001/jama.283.15.2008
- 16.↵Ouzzani M , Hammady H , Fedorowicz Z , Elmagarmid A . Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. 10.1186/s13643-016-0384-4
- 17.
- 18.↵Review Manager Web (RevMan Web) [computer program]. Version 8. The Cochrane Collaboration. 2026. https://revman.cochrane.org. 29 May 2026.
- 19.↵IntHout J , Ioannidis JPA , Borm GF . The hartung-knapp-sidik-jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol. 2014;14:25. 10.1186/1471-2288-14-25
- 20.↵Higgins JPT , Thompson SG , Deeks JJ , Altman DG . Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–560. 10.1136/bmj.327.7414.557
- 21.↵Khalid SI , Mirpuri P , Massaad E , et al . The impact of semaglutide use for weight loss on transforaminal lumbar interbody fusion outcomes. Clin Neurol Neurosurg. 2025;254:108952. 10.1016/j.clineuro.2025.108952
- 22.↵Khalid SI , Massaad E , Thomson K , Shin JH . Semaglutide exposure and its association with adverse outcomes in diabetic patients undergoing transforaminal lumbar interbody fusion for lumbar degenerative disc disease. J Neurosurg Spine. 2025;42(1):1–8. 10.3171/2024.6.SPINE24141
- 23.↵Ghali A , Lawand J , Mitchell P , et al . The use of semaglutide in patients undergoing lumbar fusion does not increase 90-day medical or 1-year implant complications. Clin Spine Surg. 2025;38(10):E579–E584. 10.1097/BSD.0000000000001800
- 24.↵Ng MK , Mastrokostas PG , Tabbaa A , et al . Semaglutide use is associated with decreased length of stay and hospital costs in patients undergoing anterior lumbar interbody fusion: a retrospective cohort study. Orthopedics. 2026;49(1):e56–e61. 10.3928/01477447-20251219-01
- 25.↵Seddio AE , Gouzoulis MJ , Vasudevan RS , et al . Semaglutide utilization associated with reduced 90-day postoperative complications following single-level posterior lumbar fusion for patients with type II diabetes. Spine J. 2025;25(3):485–493. 10.1016/j.spinee.2024.10.011
- 26.↵Baidya J , Dalton J , Baek G , et al . Patients taking GLP-1 agonists for weight-loss prior to posterior lumbar decompression and fusion have similar surgical and patient-reported outcomes. Eur Spine J. 2026. 10.1007/s00586-026-09849-6
