Surgical patients can safely use GLP-1s to lose weight and reduce risk of complications

Patients waiting for operations could safely use glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to lose excess weight and reduce their risk of surgical complications linked to their obesity, a study by researchers from the University of Birmingham has revealed.

The study highlights GLP-1 RAs are a promising medication given before surgery that helps control blood sugar and supports weight loss, potentially improving surgical outcomes and reducing health care burdens associated with obesity. However, the researchers stress an urgent need for high-quality randomised trials to validate these findings, assess cost-effectiveness, and guide implementation of the drug across diverse surgical systems.

Publishing their findings in eClinicalMedicine, the experts reveal that GLP-1 therapy led to weight reductions of up to 16.7 kg over six months, suggesting its potential as a scalable preoperative measure.

The researchers analysed data from 21 studies and 97,059 patients, 31.9% (n=30,981) received preoperative GLP-1 RA therapy. Most studies were single-centre observational cohorts from high-income countries, with no randomised trials identified. Postoperative complications were reported in 12 studies, with no evidence of increased risk in GLP-1 users (pooled odds ratio: 0.78, 95% confidence interval: 0.59–1.05).

The overall GRADE assessment for certainty of evidence was very low. In studies reporting weight loss, preoperative GLP-1 use was associated with weight loss of up to 16.7 kg or 6.0 kg/m2 over six months, though reporting varied across studies.

"People who are obese face higher risks during surgical procedures, so measures that help to reduce their weight ahead of surgery can help to improve their chances of avoiding post-operative complications. Our findings challenge current guidelines around the potential safety risks of patients on GLP-1 undergoing surgery, this guidance is based on opinions rather than high-quality evidence,” commented lead author, Dr Sivesh Kamarajah, from the University of Birmingham. "GLP-1 therapies may offer a transformative approach to surgical optimization, but robust evidence is needed to inform clinical guidelines and health policy. Given the scale of the obesity epidemic and surgical demand, prioritising research in this area is critical.”

The risk of surgery in people with obesity varies according to surgical specialty. Around a third of patients with obesity undergo surgery, most of these procedures, such as those for cancer, are time-critical.

"We are not seeing GLP-1 as a routine intervention for weight loss in clinical practice because the clinical- and cost-effectiveness of wider use remains uncertain, further highlighting the need for a trial," added Kamarajah.

The findings were reported in the paper, ‘Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression’, published in eClinicalMedicine. To access this paper, please click here