GLP-1剂量强度对ACDF术后围手术期及长期融合结局的影响

文献信息

中文摘要

背景： 高剂量胰高血糖素样肽-1受体激动剂（GLP-1 RAs）越来越多地用于肥胖管理，但其围手术期安全性及对前路颈椎间盘切除融合术（ACDF）后融合相关结局的潜在影响仍不明确。
目的： 比较接受高剂量与标准剂量GLP-1 RA治疗的患者在ACDF术后短期结局及长期融合相关结局。
研究设计/设置： 使用TriNetX研究网络的回顾性队列研究。
患者样本： 在TriNetX中识别接受ACDF的成年患者，并分为3组两两比较：标准剂量GLP-1 RA与无GLP-1暴露、高剂量GLP-1 RA与无GLP-1暴露、以及高剂量与标准剂量GLP-1 RA使用。共有112,065例患者符合所有3项比较的纳入标准。在主要剂量强度比较中，1:1倾向评分匹配后每组各保留921例患者。
结局指标： 结局包括90天医疗资源利用（再入院、急诊就诊、门诊就诊、物理治疗利用）、90天内科及急性术后并发症、90天阿片类药物暴露，以及180至720天的长期融合相关结局，包括假关节形成和后路颈椎融合。
方法： 数据查询于2026年3月9日进行。识别接受ACDF的成人，并按术前GLP-1 RA剂量强度分层。暴露定义为在索引ACDF手术前1年至1周内记录的GLP-1 RA处方强度。对每项两两比较分别进行1:1倾向评分匹配。医疗资源利用、短期并发症和阿片类药物暴露在1至90天评估，长期融合相关结局在180至720天评估。
资金/利益冲突： 本研究未获得资金。作者报告无研究特定利益冲突或相关偏倚。
结果： 在主要的高剂量与标准剂量比较中，90天医疗资源利用相似，包括再入院（11.4% vs 10.0%；p = 0.327）、急诊就诊（11.4% vs 12.3%；p = 0.564）、门诊就诊（49.8% vs 52.1%；p = 0.328）和物理治疗利用（42.0% vs 44.0%；p = 0.397）。短期并发症也相似，包括复合内科并发症（9.6% vs 8.9%；p = 0.629）、吞咽困难（10.6% vs 11.2%；p = 0.709）、血肿（6.8% vs 6.3%；p = 0.638）、发声困难（1.8% vs 1.6%；p = 0.721）和急性呼吸衰竭（2.3% vs 1.7%；p = 0.406）。阿片类药物暴露在队列间无差异（85.2% vs 83.1%；p = 0.202）。长期结局同样相似，包括假关节形成（4.0% vs 3.8%；p = 0.822）和后路颈椎融合（3.0% vs 3.7%；p = 0.398）。与匹配的非使用者相比，标准剂量和高剂量GLP-1 RA使用者的假关节形成率均较低，但更高剂量治疗未观察到额外长期获益。
结论： 与标准剂量治疗相比，高剂量GLP-1 RA治疗与ACDF术后短期医疗资源利用增加、术后并发症、阿片类药物暴露或长期融合相关风险无关。这些发现令人放心，即较高剂量GLP-1方案在该人群中似乎不会带来过度的围手术期或融合相关风险。

英文摘要

BACKGROUND CONTEXT: High-dose glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for obesity management, but their perioperative safety and potential effects on fusion-related outcomes after anterior cervical discectomy and fusion (ACDF) remain unclear.
PURPOSE: To compare short-term postoperative outcomes and longer-term fusion-related outcomes after ACDF among patients receiving high-dose versus standard-dose GLP-1 RA therapy.
STUDY DESIGN/SETTING: Retrospective cohort study using the TriNetX Research Network.
PATIENT SAMPLE: Adult patients undergoing ACDF were identified within TriNetX and stratified into 3 pairwise comparison groups: standard-dose GLP-1 RA versus no GLP-1 exposure, high-dose GLP-1 RA versus no GLP-1 exposure, and high-dose versus standard-dose GLP-1 RA use. A total of 112,065 patients met inclusion criteria across all 3 comparisons. In the primary dose-intensity comparison, 921 patients remained in each cohort after 1:1 propensity score matching.
OUTCOME MEASURES: Outcomes included 90-day healthcare utilization (readmission, emergency department visits, outpatient visits, physical therapy utilization), 90-day medical and acute postoperative complications, 90-day opioid exposure, and long-term fusion-related outcomes from 180 to 720 days, including pseudarthrosis and posterior cervical fusion.
METHODS: Data were queried on March 9, 2026. Adults undergoing ACDF were identified and stratified by preoperative GLP-1 RA dose intensity. Exposure was defined by recorded GLP-1 RA prescription strength from 1 year to 1 week before the index ACDF procedure. Separate 1:1 propensity score matching was performed for each pairwise comparison. Outcomes were evaluated at 1 to 90 days for healthcare utilization, short-term complications, and opioid exposure, and at 180 to 720 days for long-term fusion-related outcomes.
FUNDING/CONFLICTS OF INTEREST: No funding was received for this study. The authors report no study-specific conflicts of interest or associated biases.
RESULTS: In the primary high-dose versus standard-dose comparison, 90-day healthcare utilization was similar, including readmission (11.4% vs 10.0%; p = 0.327), emergency department visits (11.4% vs 12.3%; p = 0.564), outpatient visits (49.8% vs 52.1%; p = 0.328), and physical therapy utilization (42.0% vs 44.0%; p = 0.397). Short-term complications were also similar, including composite medical complications (9.6% vs 8.9%; p = 0.629), dysphagia (10.6% vs 11.2%; p = 0.709), hematoma (6.8% vs 6.3%; p = 0.638), dysphonia (1.8% vs 1.6%; p = 0.721), and acute respiratory failure (2.3% vs 1.7%; p = 0.406). Opioid exposure did not differ between cohorts (85.2% vs 83.1%; p = 0.202). Long-term outcomes were likewise similar, including pseudarthrosis (4.0% vs 3.8%; p = 0.822) and posterior cervical fusion (3.0% vs 3.7%; p = 0.398). Compared with matched non-users, both standard-dose and high-dose GLP-1 RA users had lower pseudarthrosis rates, although no additional long-term benefit was observed with higher-dose therapy.
CONCLUSIONS: High-dose GLP-1 RA therapy was not associated with increased short-term healthcare utilization, postoperative complications, opioid exposure, or long-term fusion-related risk after ACDF compared with standard-dose therapy. These findings provide reassurance that higher-dose GLP-1 regimens do not appear to confer excess perioperative or fusion-related risk in this population.