Semaglutide use is associated with higher rates of pseudarthrosis and dysphagia in patients undergoing posterior cervical fusion

BACKGROUND CONTEXT: Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has shown efficacy in managing glycemic control and obesity but its effects on surgical outcomes, particularly in posterior cervical fusion (PCF), are underexplored. PURPOSE: To evaluate the association between semaglutide use and postoperative complications, costs, and readmissions in patients undergoing PCF. DESIGN: Retrospective cohort study. PATIENT SAMPLE: Patients undergoing PCF were queried from the PearlDiver Mariner database between 2010 and 2022. OUTCOME MEASURES: Outcomes included medical and surgical complications, readmissions, emergency department visits, and associated costs within 90 days and 2 years postoperatively. METHODS: Patients with an active semaglutide prescription were propensity score-matched in a 1:5 ratio to controls based on age, sex, Elixhauser Comorbidity Index, and other clinical variables. Statistical analyses included chi-square tests and logistic regression, with significance set at p<.003 after Bonferroni correction. RESULTS: A total of 340 semaglutide users and 1,540 matched controls were included. Semaglutide use was associated with significantly higher odds of pseudoarthrosis at 2 years (OR 4.79, 95% CI 3.11–7.37; p<.001) and dysphagia (OR 2.12, 95% CI 1.46–3.03; p<.001). Hospital cost analyses revealed significant differences between groups. Same-day ($5,000 vs $11,700; p<.001) and mean 90-day costs were significantly lower ($12,200 vs $18,800; p<.001) in the semaglutide group. No differences were observed in emergency department visits or readmissions (p>.003 for all). CONCLUSIONS: Semaglutide use is associated with an increased risk of long-term complications, including pseudoarthrosis and dysphagia, as well as lower same-day and 90-day costs in patients undergoing PCF. These findings highlight the importance of careful perioperative management of semaglutide users to optimize outcomes while leveraging its purported benefits.