Abstract
In this paper, we propose a novel pharmaceutical approach to preoperative medical optimization for spinal surgery: glucagon-like peptide-1 receptor agonists (GLP-1 RAs). The adverse effects of obesity on spinal surgery outcomes are well-documented, with obese patients facing increased rates of surgical site infections, venous thromboembolism, revision, and mortality. Despite this robust body of evidence, current preoperative weight loss strategies are limited, as bariatric surgery represents the most effective, yet invasive, option. However, GLP-1 RAs offer a promising solution. These medications have repeatedly demonstrated remarkable efficacy in creating weight loss rivaling bariatric surgery. Furthermore, their convenience, dependability, and ability to control glucose, on top of evidence suggesting their potentially osteogenic, lean mass-preserving and cardioprotective properties, make GLP-1 RAs a strong, multi-dimensional solution. Although several studies have emerged examining the effect of these agents on perioperative outcomes in spinal surgery, there have yet to be any published investigations analyzing the utility of GLP-1 RAs as a weight-targeted tool for medical optimization specifically in spinal surgery. In this paper, we outline the significance of obesity's adverse influence on spinal surgery outcomes, highlight the gap in available weight loss interventions, and elucidate the osteogenic and lean mass-preserving benefits of GLP-1 RAs. In doing so, we have identified GLP-1 RAs as an exceptional tool for mitigating obesity-related complications in spinal surgery. Further focused investigation has the potential to significantly improve surgical outcomes for this population of patients.