Outcomes after Posterior Cervical Spine Surgery: A Matched Cohort Analysis and Comparison of GLP-1 Receptor Agonist Use and Bariatric Surgery in Patients with Type 2 Diabetes

Why clinicians should know about it

• Picked for Spine Surgery (paper of the day, 23 October 2026): Posterior cervical surgery complications and preoperative optimization

Abstract

BACKGROUND CONTEXT: Obesity and diabetes can increase perioperative risk, especially in posterior cervical spine surgery. Bariatric surgery provides durable weight loss but carries surgical and nutritional risks, while glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are non-surgical alternatives that may optimize weight and metabolic status preoperatively. Evidence evaluating GLP-1 therapy in spine surgery is limited. PURPOSE: To evaluate associations between preoperative GLP-1 RA use and perioperative, short-term, and long-term complications following posterior cervical spine surgery in patients with type 2 diabetes, including comparisons to matched controls and patients with prior bariatric surgery. STUDY DESIGN: Retrospective database analysis. PATIENT SAMPLE: Patients with type 2 diabetes treated with metformin undergoing posterior cervical spine surgery between 2010 and 2023 were identified in the PearlDiver Mariner database. Patients were stratified into GLP-1 users, non-GLP-1 controls, and patients with prior bariatric surgery. OUTCOME MEASURES: Physiologic measures included perioperative outcomes and postoperative complications assessed at 90 days and 2 years, including pneumonitis, surgical site infection, revision surgery, readmission, nutritional deficiency, and other medical and surgical complications. METHODS: The PearlDiver Mariner database was queried for eligible patients. Propensity-score matching adjusted for baseline cohort differences. Outcomes included perioperative, 90-day, and 2-year complications, with BMI-stratified analyses conducted within the matched GLP-1 and control cohort. Benjamini-Hochberg false discovery rate correction was applied for multiple comparisons. RESULTS: GLP-1 users demonstrated lower odds of perioperative complications, including pneumonitis (OR 0.57; 95% CI 0.43-0.75; p <0.001). At 90 days, GLP-1 users experienced reduced odds of surgical site infection (OR 0.72; 95% CI 0.65-0.80; p <0.001), revision surgery (OR 0.33; 95% CI 0.29-0.36; p <0.001), readmission (OR 0.82; 95% CI 0.76-0.90; p <0.001), and other complications. At 2 years, GLP-1 users had lower odds of revision surgery (OR 0.31; 95% CI 0.28-0.34; p <0.001), nutritional deficiency (OR 0.62; 95% CI 0.59-0.66; p <0.001), and other complications. Exploratory BMI-stratified analyses suggested similar directional trends across overweight and obese patients. Comparisons to prior bariatric surgery patients showed no significant differences. CONCLUSIONS: Preoperative GLP-1 RA use was associated with reduced perioperative, short-term, and long-term complications following posterior cervical spine surgery in patients with type 2 diabetes. When compared with a matched bariatric surgery cohort, no significant differences in postoperative outcomes were observed. These findings should be interpreted in the context of potential residual confounding and support further prospective investigation of GLP-1 therapy as a strategy for preoperative metabolic optimization in posterior cervical spine surgery. CLASSIFICATIONS: Cervical Spine, Outcomes Research, Risk Factors, Perioperative Complications.

Abstract as published, via PubMed.