The study highlights glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as a promising medication given before surgery that help control blood sugar and support weight loss - potentially improving surgical outcomes and reducing healthcare 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.
They analysed data from 21 studies encompassing over 97,000 surgical patients, 31.9% of whom received preoperative GLP-1 therapy – discovering that, across 12 studies reporting postoperative outcomes, use of the medication was not associated with increased risk.
The paper is co-authored by Professor Sheraz Markar, Professor of Upper Gastrointestinal Surgery and Director of the Surgical Interventional Trials Unit at the Nuffield Department of Surgical Sciences, University of Oxford, who served as a senior author on the study.
Lead author Dr Sivesh Kamarajah, from the University of Birmingham, commented: '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 potential safety risks of patients on GLp-1 undergoing surgery – this guidance is based on opinions rather than high quality evidence.'
GLP-1 therapies may offer a transformative approach to surgical optimisation, 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.
GLP-1 RAs were originally developed for type 2 diabetes management but have emerged as a powerful agent for weight loss. However, their perioperative safety has remained uncertain, particularly amid concerns about delayed gastric emptying and aspiration risk.
Obesity remains a major global public health challenge, particularly among surgical patients, where it can be associated with increased risk around the operation and into the longer term. While preoperative weight management strategies are often used to mitigate these risks, scalable interventions remain limited.
The risk of surgery in people who are obese are as high but varies according to surgical specialty. Around a third of patients who are obese 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 Dr Kamarajah.
Read the full paper ‘Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression’ in eClinical Medicine.