In a groundbreaking systematic review recently published in eClinicalMedicine, researchers have illuminated the promising role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as a preoperative intervention to improve surgical outcomes for patients with obesity. This study casts fresh light on a medication class traditionally prescribed for type 2 diabetes, now emerging as a potentially transformative tool in perioperative care focused on mitigating the heightened risks obese patients face when undergoing elective surgeries.
Obesity is well-documented as a formidable risk factor in surgical settings, complicating procedures and exacerbating postoperative complications. The chronic metabolic derangements and physiological stress imposed by excessive adiposity increase vulnerability to infections, delayed wound healing, cardiovascular events, and respiratory complications during the perioperative period. Despite these risks, scalable and effective preoperative weight management strategies have remained elusive, limiting clinicians’ ability to optimize patient outcomes proactively.
GLP-1 receptor agonists, originally developed to improve glycemic control in type 2 diabetes, have demonstrated significant off-label benefits in weight reduction due to their multifaceted mechanism of action. These drugs enhance insulin secretion, suppress glucagon release, slow gastric emptying, and promote satiety through central nervous system pathways. Collectively, these actions contribute to substantial and sustained weight loss. Until now, however, their safety and efficacy in the preoperative context have not been comprehensively evaluated, especially given concerns about delayed gastric emptying and the theoretical risk of pulmonary aspiration during anesthesia.
The authors, headed by Dr. Sivesh Kamarajah of the University of Birmingham, conducted an extensive literature review encompassing 21 studies and more than 97,000 surgical patients. Approximately one-third of these patients received GLP-1 receptor agonists as a preoperative intervention. The meta-analysis and meta-regression performed carefully examined postoperative complication rates, weight loss trajectories, and potential adverse events linked to GLP-1 RA therapy administered before elective surgery.
Remarkably, the findings reveal that GLP-1 receptor agonists resulted in weight losses of up to 16.7 kilograms over a six-month span. This magnitude of weight reduction is clinically meaningful and likely to translate into diminished surgical risk profiles. Even more compellingly, across 12 studies reporting postoperative outcomes, GLP-1 use was not associated with any increased risk of surgical complications or mortality. This challenges prevailing clinical guidance, which often excludes GLP-1 therapies from preoperative protocols due to safety concerns rooted mainly in expert opinion rather than robust empirical data.
The surgical community has long been cautious about pharmacologic interventions targeting weight reduction in the perioperative period. The anxiety surrounding GLP-1 RAs centers on their effect in delaying gastric motility, potentially elevating aspiration risk during induction of anesthesia. However, this comprehensive review presents strong evidence mitigating those fears, suggesting that the pharmacodynamic effects do not translate into clinically significant perioperative hazards. This revelation not only broadens surgical pharmacotherapy horizons but may catalyze paradigm shifts in preoperative optimization standards.
In-depth interrogation of the data indicates that the benefits of GLP-1 RA therapy extend beyond pure weight loss. Improved glycemic control prior to surgery can reduce hyperglycemia-induced immunosuppression and vascular damage, both of which are pivotal contributors to postoperative infections and poor wound healing. Thus, GLP-1 receptor agonists may confer a dual advantage: modulating both metabolic homeostasis and body composition to support better surgical outcomes.
Despite these promising results, Dr. Kamarajah and colleagues stress the critical need for high-quality randomized controlled trials to validate safety and efficacy conclusively. The current evidence, while persuasive, derives largely from observational studies and meta-analyses prone to inherent biases and heterogeneity. Randomized trials will be essential to confirm these findings, elucidate optimal dosing strategies, and establish cost-effectiveness—crucial parameters for widespread clinical adoption.
The timing of intervention is another vital consideration. Since many surgeries, especially oncological procedures, are time-sensitive, the window to achieve meaningful weight reduction with GLP-1 receptor agonists may be limited. Future research must delineate which patient populations and surgical specialties stand to benefit most, enabling tailored approaches that balance urgency with optimization.
From a public health perspective, the implications of integrating GLP-1 receptor agonists into preoperative care pathways are profound. Obesity prevalence continues to escalate globally, burdening healthcare systems and amplifying surgical demand. Establishing effective, scalable, and safe interventions can reduce postoperative complication rates, shorten hospital stays, and alleviate resource constraints—culminating in improved patient outcomes and systemic efficiencies.
This study also prompts a reevaluation of current clinical guidelines that sometimes contraindicate GLP-1 receptor agonist use in the perioperative setting. With evidence underscoring their safety and potential benefits, there is a compelling argument for guideline committees to expedite updates that incorporate these findings, fostering evidence-based practice evolution.
Furthermore, the exploration of GLP-1 receptor agonists opens avenues for innovative multidisciplinary collaboration among endocrinologists, surgeons, anesthetists, and policymakers. Such collaborative frameworks will be indispensable in designing implementation strategies, ensuring patient safety, and monitoring long-term outcomes in broader surgical cohorts.
In conclusion, the evaluation of preoperative GLP-1 receptor agonists represents a significant stride toward addressing the intersection between obesity and surgical risk. While the promise is evident, the medical community awaits rigorously conducted prospective trials to underpin policy and guideline changes. Should these medications be validated as safe and effective preoperative adjuncts, they could revolutionize surgical preparation, offering hope for improved prognosis to a vulnerable patient population.
Subject of Research: People
Article Title: Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression
News Publication Date: 12-Aug-2025
Keywords: Human health; Surgery; Body weight; Obesity
