Perioperative SGLT2 Inhibitor Use is Associated With Improved Outcomes After ACDF: A Propensity-matched Analysis.

OBJECTIVE: The objective of the present investigation is to evaluate the association between perioperative SGLT2i use and short-term postoperative complications and long-term outcomes following ACDF.

SUMMARY OF BACKGROUND DATA: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are a class of diabetic medications that provide cardiorenal benefits beyond glycemic control. Despite these benefits, SGLT2i use has been associated with a range of adverse effects. However, the literature remains limited regarding the impact of SGLT2i on perioperative recovery and complications in patients undergoing anterior cervical discectomy and fusion (ACDF).

METHODS: A retrospective cohort study was conducted using the TriNetX database. Patients undergoing ACDF were identified and stratified by preoperative SGLT2i use. After 1:1 propensity score matching on demographics and comorbidities, 1,585 patients remained per cohort. Outcomes included postoperative events and long-term sequelae. Risk ratios (RR), 95% confidence intervals (CI), and P values were calculated; Kaplan-Meier curves were used to assess long-term event incidence.

RESULTS: The SGLT2i cohort demonstrated lower rates of postoperative emergency department visits (1.3% vs. 2.2%; RR 0.59, 95% CI 0.34-0.99; P=0.047). At 1-year follow-up, patients receiving SGLT2i had lower rates of pseudoarthrosis (4.9% vs. 6.8%; RR 0.73, 95% CI 0.55-0.97; P=0.028). Reoperation rates at 5 years were also lower in the SGLT2i cohort (2.2% vs. 3.5%; RR 0.64, 95% CI 0.42-0.97; P=0.033). No significant differences were observed in ICU admission, surgical site infection, urinary tract infection, acute kidney injury, or readmission.

CONCLUSION: Preoperative SGLT2 inhibitor use was associated with reduced postoperative emergency department utilization and lower rates of early pseudarthrosis following ACDF, without an increased risk of short-term complications. Recognition of these risks should inform preoperative counselling, postoperative surveillance, and multidisciplinary care planning for patients undergoing ACDF.

STUDY DESIGN: Retrospective Cohort Study.