Semaglutide use before single-level lumbar fusion associated with fewer readmissions and 90-day costs.

CONTEXT: Semaglutide, a glucagon-like protein-1 receptor agonist used in diabetes and obesity management, has demonstrated perioperative benefits in other surgical populations. However, its role in spine surgery remains unclear. AIMS: This study aims to evaluate whether patients undergoing single-level lumbar fusion demonstrate: (1) fewer medical complications; (2) surgical complications; and (3) healthcare utilization as measured by readmissions and costs. SETTINGS AND DESIGN: A retrospective cohort study using a national claims database from 2010 to 2021. SUBJECTS AND METHODS: Patients with diabetes mellitus undergoing single-level lumbar fusion were identified and matched 1:5 using propensity scores based on age, sex, body mass index, smoking status, diabetes-related complications, insulin/metformin use, and Elixhauser Comorbidity Index (semaglutide: =3452; controls: =15,486). Outcomes included 90-day medical/surgical complications, readmissions, and costs. Multivariate logistic regression was used to calculate odds ratios, 95% confidence intervals, and values, with statistical significance set at < 0.003 after Bonferroni correction. STATISTICAL ANALYSIS USED: Multivariate logistic regression for binary outcomes; cost comparisons conducted with appropriate statistical adjustments. RESULTS: No significant differences were observed in rates of cerebrovascular accidents, myocardial infarctions, venous thromboembolism, pneumonia, hypoglycemia, or surgical site infections (SSIs) ( > 0.05 for all). Semaglutide users had significantly lower 90-day readmission rates (8.7% vs. 11.4%, < 0.0001) and reduced 90-day costs-of-care ( < 0.0001). A trend toward fewer SSIs was noted (2.5% vs. 3.2%, = 0.018), though not statistically significant. CONCLUSIONS: Semaglutide use before single-level lumbar fusion is associated with reduced 90-day readmissions and costs without increasing complication risk.