Preoperative GLP-1 receptor agonist therapy may support clinically meaningful weight loss without a clear signal of increased perioperative risk, though current evidence certainty is very low.
Meta-Analysis
Does preoperative GLP-1 RA therapy improve weight loss and perioperative safety in patients undergoing elective surgery?
Preoperative GLP-1 RA therapy may offer clinically meaningful weight loss without increasing perioperative risk in elective surgery patients, though current evidence is of very low certainty and requires robust randomized trials.
Background: Obesity remains a major global public health challenge, particularly among surgical patients, where it can be associated with increased perioperative and longer-term risk. While preoperative weight management strategies are often used to mitigate these risks, scalable interventions remain limited. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are an emerging pharmacological approach for weight loss, but their perioperative safety remains uncertain. This study aimed to assess the safety and efficacy of preoperative GLP-1 therapy in elective surgical systems. Methods: statistic and visualised using a standard forest plot. Potential publication bias and small study effects were assessed using visual inspection of funnel plots and Egger's test. This study is registered with PROSPERO, CRD420251027809. Findings: over six months, though reporting varied across studies. Interpretation: Preoperative GLP-1 RA therapy may support clinically meaningful weight loss without a clear signal of increased perioperative risk, offering a potentially scalable strategy for surgical optimisation. However, the certainty of current evidence is very low, with most studies observational in design and at risk of bias. Amid rising global obesity rates and mounting surgical backlogs, the role of GLP-1RAs in perioperative care remains a critical unanswered question. Robust randomised trials are needed to establish their clinical value, cost-effectiveness, and implementation potential across diverse surgical systems. Prioritisation by funders and policymakers are needed as part of broader health policy agendas to improve population health and health system resilience. Funding: NIHR Doctoral Research Fellowship and NIHR Exeter Biomedical Research Centre Senior Investigator Fellowship.
Kamarajah et al. (Tue,) conducted a meta-analysis in Obesity in patients undergoing elective surgery. Preoperative GLP-1 receptor agonists was evaluated on Perioperative safety and weight loss. Preoperative GLP-1 receptor agonist therapy may support clinically meaningful weight loss without a clear signal of increased perioperative risk, though current evidence certainty is very low.
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