If you take a GLP-1 drug and have spinal fusion surgery scheduled, the largest synthesis of the evidence so far found no sign that the drug makes the operation riskier. A systematic review and meta-analysis published on 17 September pooled seven studies covering 28,525 adults who underwent lumbar fusion, and found no statistically significant difference in reoperation, infection, wound problems, breathing complications or blood clots between patients taking a GLP-1 receptor agonist beforehand and those who were not.
What the review pooled
The authors searched PubMed, Embase and the Cochrane Library from inception through 14 May 2026, and registered the protocol in advance (PROSPERO CRD420261414637). Seven retrospective cohort studies met the criteria; six of them used propensity-score matching or another matching strategy to make the exposed and unexposed groups comparable. Risk of bias was assessed with ROBINS-I, the standard tool for non-randomised studies.
Every pooled comparison came back non-significant. Reoperation or revision: odds ratio 0.74, 95% confidence interval 0.44 to 1.24. Postoperative infection: 0.83, 0.68 to 1.00. Wound complications: 0.86, 0.65 to 1.12. Respiratory complications after surgery: 1.08, 0.63 to 1.84. Deep vein thrombosis, pulmonary embolism and unplanned emergency department visits also showed no significant difference.
Three of those four point estimates sit below 1, which on its face favours the patients who were taking a GLP-1 drug. The intervals are the part that matters. The reoperation interval runs from a 56% reduction to a 24% increase — wide enough to contain a real benefit, a real harm, or nothing at all. The infection result is the closest to significance of the set, and its interval stops exactly at 1.00, which is another way of saying the question is not settled.
How this fits the perioperative picture
The perioperative debate about GLP-1 drugs has been dominated by a different concern. These drugs slow stomach emptying, so food can remain in the stomach longer than a standard fasting window assumes, raising the risk of regurgitation and aspiration once a patient is anaesthetised. That is the question anaesthesia guidance has been written around, and it is not the question this review asked.
This review looked past the airway to the surgical result itself: whether the wound heals, whether the patient comes back for another operation, whether a clot forms afterwards. On those outcomes it found nothing. For someone weighing whether to interrupt a drug that is managing their weight or their diabetes ahead of an elective back operation, that is useful reassurance about one half of the problem and no information at all about the other half. The two halves are often collapsed together in discussion of GLP-1 side effects, and they should not be.
Every study in the pool was observational, and most drew on large administrative databases that record billing codes rather than clinical detail. That leaves confounding by indication unresolved: patients who were prescribed a GLP-1 drug and then cleared for elective spinal fusion may be healthier, more closely monitored, or further along in treating their diabetes than those who were not, and matching on recorded variables cannot correct for what was never recorded in the first place. The pooled estimates drifting below 1 are as easily explained by that as by any protective effect.
The review’s abstract does not establish whether patients held the drug before surgery, how long they had been taking it, or at what dose, so it cannot say whether some perioperative management protocol is doing the work behind the absence of a signal. The authors themselves call for prospective studies with standardised exposure definitions before these findings are treated as settled, and they frame their conclusion narrowly: the available observational evidence did not identify a signal of increased risk, which is not the same as establishing that there is none.
Sources: Alves MLM, Moura Costa AODS, Costa JDVM, et al. “Do Preoperative Glucagon-Like Peptide-1 Receptor Agonists Influence Lumbar Fusion Outcomes? A Systematic Review and Meta-Analysis.” International Journal of Spine Surgery, published online 17 September 2026. doi:10.14444/8954 · PubMed 42754392. Protocol: PROSPERO CRD420261414637.
