A systematic review and meta-analysis assessed whether preoperative exposure to GLP-1 receptor agonists was associated with surgical or postoperative outcomes in adults undergoing lumbar fusion. The authors included seven retrospective cohorts involving 28,525 people. Across the outcomes they evaluated, the review did not identify a statistically significant signal of increased postoperative risk associated with preoperative GLP-1 receptor agonist exposure.
That wording matters. The paper pooled observational studies, predominantly based on large administrative data sources. It does not test a single protocol, does not randomise exposure, and does not establish that a preoperative GLP-1 receptor agonist is independently responsible for any outcome. Its contribution is a structured summary of the evidence available through 14 May 2026.
How the review was assembled
The authors searched PubMed, Embase and the Cochrane Library from inception through 14 May 2026. They included comparative studies of adults undergoing lumbar fusion with and without preoperative GLP-1 receptor agonist exposure. Two reviewers independently screened studies, extracted data and assessed risk of bias with ROBINS-I. The protocol was registered prospectively in PROSPERO as CRD420261414637.
Seven cohorts met the criteria. Six used propensity score matching or another matching strategy. The authors used random-effects meta-analysis to calculate odds ratios with 95% confidence intervals. Matching and pooling can improve the structure of an observational comparison, but neither step removes the limitations of the original records or turns them into a randomised trial.
What the pooled results showed
For reoperation or revision, the pooled odds ratio was 0.74, with a 95% confidence interval from 0.44 to 1.24 and P = 0.25. For postoperative infection, the reported odds ratio was 0.83, with a 95% confidence interval from 0.68 to 1.00 and P = 0.05. Wound complications had an odds ratio of 0.86, with a 95% confidence interval from 0.65 to 1.12 and P = 0.26.
For postoperative respiratory complications, the review reported an odds ratio of 1.08, with a 95% confidence interval from 0.63 to 1.84 and P = 0.69. Deep vein thrombosis, pulmonary embolism and unplanned emergency-department visits also did not differ significantly in the included evidence. These estimates are pooled associations, not predictions for a procedure or an individual.
Why GLP-1 exposure still needs prospective testing
The authors conclude that the available observational evidence did not identify a signal of increased postoperative risk associated with preoperative exposure. That is narrower than demonstrating no risk. The GLP-1 question remains open because the confidence intervals show the range of estimates compatible with the pooled data, and different cohorts can vary in population, coding, exposure definition, procedure details and perioperative management.
The review itself calls for prospective studies with standardised exposure definitions and perioperative management protocols. This is a key next step because the question is not just whether an administrative record contains a GLP-1 receptor agonist code. Future work would need to define timing, comparators, outcome assessment and relevant clinical context in advance.
What this review does and does not compare
The paper does not compare individual compounds, establish a ranking between them, or evaluate Peptra Labs materials. It also does not provide a protocol for surgical or clinical decisions. Retatrutide and Tirzepatide are distinct research materials and were not individual comparators in the meta-analysis. Their mention here should not be read as an extension of the review’s findings.
For separate research context, see the Retatrutide research buyer guide and Retatrutide research reference hub. Peptra Labs materials remain within a Research Use Only boundary.
The measured conclusion is therefore limited: seven retrospective cohorts did not show a statistically significant increase in the postoperative outcomes examined. The result is useful for defining a research gap, while prospective evidence is still needed to establish what the associations mean.
References
- 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. 2026. PubMed
- PROSPERO. Registration CRD420261414637. Registry record
- Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016. Article
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