Perioperative SGLT2 Inhibitor Use is Associated With Improved Outcomes After ACDF: A Propensity-matched Analysis.
retrospective_cohort · Level III
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- Also identified by DOI 10.1097/BRS.0000000000005815.
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Abstract
Retrospective Cohort Study. 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. 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). 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. 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. 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.