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Introduction <p>Bariatric surgery provides durable weight loss and metabolic benefits. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used preoperatively, yet their impact on surgical outcomes is unclear. We assessed whether preoperative GLP-1 therapy improves postoperative (surgery-anchored) weight loss and metabolic outcomes.</p> Methods <p>We retrospectively analysed a prospectively maintained single-centre cohort of adults undergoing primary bariatric surgery (January 2022–December 2023). Preoperative pharmacotherapy comprised GLP-1 RAs during optimisation. Primary outcomes were preoperative and postoperative weight loss, BMI, and %EWL at 3, 6, and 12 months (anchored to day-of-surgery metrics). Secondary outcomes were overall (initial-anchored) weight loss, diabetes remission, hypertension improvement, complications, and length of stay. Comparisons used t/Mann–Whitney U and χ²/Fisher’s exact tests; multivariable logistic regression evaluated predictors of &gt;50% EWL at 12 months and diabetes remission.</p> Results <p>Of 216 patients screened, 193 were analysed (111 pharmacotherapy; 82 no pharmacotherapy). Baseline characteristics were comparable except age (older in pharmacotherapy group). Preoperative weight loss was greater with GLP-1 therapy (median 9.0 vs 5.0 kg; p=0.001). Postoperative surgery-anchored weight, BMI, and %EWL at 3, 6, and 12 months did not differ (all p≥0.19). In sensitivity analyses anchored to initial weight, overall %TWL was greater with GLP-1 at 12 months (34.5% vs 29.5%; p=0.013) and at final follow-up (37.8% vs 35.1%; p=0.005). GLP-1 therapy did not independently predict &gt;50% EWL at 12 months (adjusted OR 1.60, 95% CI 0.81–3.15; p=0.172). Diabetes and hypertension outcomes were similar, while major complications were fewer with GLP-1 (0/111 vs 5/82).</p> Conclusions <p>Preoperative GLP-1 therapy augments preoperative weight loss but does not alter the direct surgical weight-loss effect or metabolic remission at 12 months. As part of multimodal optimisation, GLP-1 RAs may contribute to greater overall (initial-anchored) weight loss in selected patients. Definitive trials are needed to define indications, timing, and cost-effectiveness.</p>

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Does Preoperative GLP-1 Therapy Improve Postoperative Bariatric Surgery Outcomes? A Single-Centre Retrospective Observational Study

  • 期刊论文

  • 发表日期：

    2026年2月13日

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  • Muhammad Mushtaq,
  • Mohammed Hamid,
  • Arifur Rahman,
  • Farhan Javed,
  • Mohamed Talaat Issa,
  • Mushal Naqvi,
  • Syed Adnan Kabir,
  • Salman Mirza,
  • Amir Khan,
  • Muhammad Karim

摘要

Introduction

Bariatric surgery provides durable weight loss and metabolic benefits. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used preoperatively, yet their impact on surgical outcomes is unclear. We assessed whether preoperative GLP-1 therapy improves postoperative (surgery-anchored) weight loss and metabolic outcomes.

Methods

We retrospectively analysed a prospectively maintained single-centre cohort of adults undergoing primary bariatric surgery (January 2022–December 2023). Preoperative pharmacotherapy comprised GLP-1 RAs during optimisation. Primary outcomes were preoperative and postoperative weight loss, BMI, and %EWL at 3, 6, and 12 months (anchored to day-of-surgery metrics). Secondary outcomes were overall (initial-anchored) weight loss, diabetes remission, hypertension improvement, complications, and length of stay. Comparisons used t/Mann–Whitney U and χ²/Fisher’s exact tests; multivariable logistic regression evaluated predictors of >50% EWL at 12 months and diabetes remission.

Results

Of 216 patients screened, 193 were analysed (111 pharmacotherapy; 82 no pharmacotherapy). Baseline characteristics were comparable except age (older in pharmacotherapy group). Preoperative weight loss was greater with GLP-1 therapy (median 9.0 vs 5.0 kg; p=0.001). Postoperative surgery-anchored weight, BMI, and %EWL at 3, 6, and 12 months did not differ (all p≥0.19). In sensitivity analyses anchored to initial weight, overall %TWL was greater with GLP-1 at 12 months (34.5% vs 29.5%; p=0.013) and at final follow-up (37.8% vs 35.1%; p=0.005). GLP-1 therapy did not independently predict >50% EWL at 12 months (adjusted OR 1.60, 95% CI 0.81–3.15; p=0.172). Diabetes and hypertension outcomes were similar, while major complications were fewer with GLP-1 (0/111 vs 5/82).

Conclusions

Preoperative GLP-1 therapy augments preoperative weight loss but does not alter the direct surgical weight-loss effect or metabolic remission at 12 months. As part of multimodal optimisation, GLP-1 RAs may contribute to greater overall (initial-anchored) weight loss in selected patients. Definitive trials are needed to define indications, timing, and cost-effectiveness.