Is There an Association Between Semaglutide Usage and Additional Surgical Interventions Following Transforaminal Lumbar Interbody Fusion?

Using data from an all-payor database, researchers found that semaglutide usage is potentially associated with a higher likelihood of additional surgical interventions within 1-year post-transforaminal lumbar interbody fusion (TLIF). The association is stronger among those on the medication for longer durations.

“Semaglutide, a novel glucagon-like peptide-1 receptor agonist, has transformed the therapeutic landscape for type-2 diabetes,” the authors wrote. “However, its effect on osteoclast activity and potential to induce weight-related muscle loss raises concerns about its impact on spinal surgical outcomes.”

Considering this, researchers set out to determine semaglutide's potential impact on patients who underwent TLIF.

“Evaluating semaglutide's influence on TLIF is imperative, given the procedure's reliance on successful bony fusion to prevent postoperative instability and further interventions,” the authors wrote.

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For their study, researchers analyzed patient data using an all-payor database, MARINER. They specifically identified patients with type-2 diabetes mellitus (aged 18-74 years) who underwent short segment fusions (≤ 3 level) TLIFs between 2018 and 2022. They grouped patients by whether they were exposed to semaglutide or not. Age, gender, comorbidity status, levels of surgery, and insulin dependence were used for a comprehensive 1:1 exact match. Additionally, Kaplan-Meier (KM) survival curves and log-rank testing were performed to study the probability of additional surgery within 1 year, and the duration of therapy KM was also analyzed to understand how semaglutide use duration impacted outcomes.

A total of 900 patients were identified after the 1:1 matching with an equal distribution between the semaglutide-exposed and non-exposed cohorts. The majority of patients in both groups were aged 55 to 65 years, and 59.3% were female (p > .99).

Analysis showed that the likelihood of undergoing an additional surgery within 1-year post-TLIF was significantly elevated in the semaglutide-exposed group compared with the non-exposed group (odds ratio = 7.43 [95% CI, 4.57 to 12.09]). Further, the diverging survival curves in the Kaplan-Meier survival analysis suggested a direct correlation between prolonged semaglutide use and increased probability of subsequent surgeries within 1 year of the index TLIF.

“Semaglutide exposure appears to be associated with a higher likelihood of additional surgeries within 1-year post-TLIF, especially in patients on the medication for longer durations,” the authors concluded. “While the mechanisms remain speculative, potential impacts on bone turnover and the onset of muscle loss may be contributory factors. Further research is needed to elucidate the exact mechanisms and to develop strategies for optimizing surgical outcomes in these patients.”

Reference
Khalid SI, Massaad E, Shin JH. Semaglutide exposure and its association with adverse outcomes in patients undergoing TLIF for lumbar degenerative disc disease. Abstract presented at: American Association of Neurological Surgeons 2024 Scientific Meeting; May 3-6, 2024; Chicago, IL. Accessed April 23, 2024. https://annualmeeting.aans.org/.