Preoperative Use of GLP-1 Receptor Agonists Is Associated With Reduced Risk of Postoperative DVT and Mortality in Patients Undergoing Lumbar Laminectomy

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STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate the association between preoperative glucagon-like peptide-1 receptor agonist (GLP-1 RA) use and postoperative outcomes in patients undergoing lumbar laminectomy. SUMMARY OF BACKGROUND DATA: GLP-1 RAs have gained prominence for their weight management benefits. Emerging evidence suggests their preoperative use may reduce postoperative complications, but data specific to lumbar laminectomy are limited. METHODS: We conducted a retrospective cohort study using the TriNetX research database to identify patients undergoing lumbar laminectomy over the past 20 years using Current Procedural Terminology (CPT) codes 63047 and 63048. Patients were stratified into 2 cohorts, those who used GLP-1 RAs within 1 year preoperatively and those who did not. Propensity score matching (PSM) was performed at a 1:1 ratio to balance demographics and medical comorbidities, including race, age at index surgery, gender, ethnicity, hypertension, diabetes, obesity, and other comorbidities. The primary outcomes were 180-day medical complications postoperatively. Using χ2 analysis, risk ratios (RRs), 95% CI, and P values were calculated, with statistical significance at P<0.05. RESULTS: A total of 4223 patients with preoperative GLP-1 RA were identified and propensity score matched with 182,656 control patients without preoperative GLP-1 RA use. After matching, 4220 patients were identified in each cohort, and their postoperative outcomes were compared. Patients using preoperative GLP-1 RAs had a 50% reduction in DVT (0.6% vs. 1.2%, RR=0.496, 95% CI: 0.308-0.801, P=0.0034) and a 43% reduction in all-cause mortality (0.8% vs. 1.4%, RR=0.551, 95% CI: 0.359-0.847, P=0.0058) compared with nonusers. CONCLUSIONS: Preoperative GLP-1 RA use is associated with a reduced postoperative risk of DVT and mortality in patients undergoing lumbar laminectomy. These findings suggest GLP-1 RAs may have a protective association in the postoperative period. Future prospective studies are warranted to validate these results and explore underlying mechanisms. LEVEL OF EVIDENCE: Level III-retrospective, comparative cohort study.

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