ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Differential impact of pre-operative tirzepatide compared to glucagon-like-peptide-1 single receptor agonists on outcomes of spinal fusion surgery in obese patients.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
STUDY
designRetrospective, propensity score-matched cohort study. PURPOSE: To determine if outcomes following spinal fusion differ between obese patients prescribed Tirzepatide and single receptor glucagon-like-peptide-1 (srGLP-1) agonists preoperatively.
methodsData was collected from the TriNetX Research Network. Obese patients undergoing spinal fusion that were prescribed tirzepatide alone in the 6 months preceding surgery, were matched 1:1 based on demographics, comorbidities, medication use, and surgical procedure with those prescribed an srGLP-1 agonist alone in the year prior to surgery. Early (90-day) outcomes included UTI, thrombotic or embolic events, and AKI. Long-term outcomes (2 years) include revision, pseudarthrosis, and post-laminectomy syndrome.
resultsA total of 918 matched pairs were analyzed. At 90-days after surgery, tirzepatide patients experienced fewer embolic or thrombotic events (RR 0.41, 95% CI 0.22-0.76, p = 0.003), lower UTI rates (RR 0.47, 95% CI 0.32-0.69, p < 0.001) and less AKIs (RR 0.42, 95% CI 0.26-0.69, p < 0.001) compared to srGLP-1 patients. At 2 years after surgery tirzepatide users had fewer instances of revision (RR 0.65, 95% CI 0.49-0.87, p = 0.003), pseudarthrosis (RR 0.41, 95% CI 0.25-0.68, p < 0.001), post-laminectomy syndrome (RR 0.58, 95% CI 0.31-0.68, p < 0.001) compared to srGLP-1 users.
conclusionsIn a propensity-matched analysis, obese spinal fusion patients treated with Tirzepatide compared to srGLP-1 agonists, had lower rates of early postoperative thrombotic and embolic events, UTIS, and AKIs. Additionally, the Tirzepatide fusion cohort had significantly lower rates of pseudarthrosis, revision surgery, and post-laminectomy syndrome 2 years after surgery. These findings support the potential protective physiological impact of Tirzepatide over srGLP-1s in obese patients undergoing spinal fusion.
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