Spine - 2026-08-05 - Journal Article
Perioperative SGLT2 Inhibitor Use is Associated With Improved Outcomes After ACDF: A Propensity-matched Analysis.
Miller M, Meade M, Delgadillo B, Sbaih O, Nanavati R, Ng M, Smith H, Gupta N, DiCiurcio W, Middleton C, Fehr S, Schroeder G, Kepler C, Woods B
Topics
Key Takeaway
Perioperative SGLT2 inhibitor use in diabetic ACDF patients was associated with a 27% reduction in 1-year pseudarthrosis (4.9% vs. 6.8%) and a 36% reduction in 5-year reoperation rates (2.2% vs. 3.5%) after propensity matching.
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Summary
This retrospective TriNetX database study compared short- and long-term ACDF outcomes in diabetic patients stratified by perioperative SGLT2 inhibitor use after 1:1 propensity score matching on demographics and comorbidities. SGLT2i users had significantly fewer ED visits (1.3% vs. 2.2%, RR 0.59), lower 1-year pseudarthrosis rates (4.9% vs. 6.8%, RR 0.73), and lower 5-year reoperation rates (2.2% vs. 3.5%, RR 0.64). No significant differences were detected in SSI, AKI, UTI, ICU admission, or readmission.
Key Limitation
Database-level coding cannot distinguish perioperative SGLT2i discontinuation (standard anesthesia protocol recommends holding 3–4 days preoperatively) from continued use, making the true exposure window and mechanism of benefit unverifiable.
Original Abstract
STUDY DESIGN
Retrospective Cohort Study.
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.