Preoperative GLP-1 Receptor Agonist Use and Postoperative Outcomes Across Plastic and Reconstructive Surgery: A Systematic Review and Meta-Analysis

This is the authors' abstract. We don't add key points for this paper.

Introduction Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for pre-operative weight loss before body-contouring procedures, yet their effects on wound healing are poorly characterised and evidence on post-operative complications is conflicting. Methods We searched PubMed, Embase, Cochrane, ClinicalTrials.gov and the WHO ICTRP (to May 2026) for comparative studies of pre-operative GLP-1 RA use versus no use in adults undergoing plastic and reconstructive surgery. Risk ratios (RR) were pooled using random-effects models (REML; Hartung-Knapp-Sidik-Jonkman confidence intervals [CI]); pre-specified population subgroups were compared. Analyses used R (version 4.3). Results In total, 13 studies (n = 17,426; 8,745 GLP-1 RA users) were included. Pre-operative GLP-1 RA use was not associated with wound dehiscence (RR 1.05; 95% CI 0.73-1.52), surgical site infection (RR 0.83; 0.60-1.16), seroma (RR 1.12; 0.67-1.87), haematoma (RR 1.13; 0.67-1.90) or venous thromboembolism (RR 0.61; 0.34-1.08). Hypertrophic scarring was increased (RR 1.55; 95% CI 1.01-2.38). Tests for differences between the general-population, post-bariatric and reconstructive subgroups were non-significant for all outcomes except surgical site infection ( P < .001), which showed lower rates in the reconstructive subgroup. Conclusion In adults undergoing plastic and reconstructive surgery, pre-operative GLP-1 RA use was not associated with an overall increase in post-operative complications, apart from a modest increase in hypertrophic scarring, and population subgroups did not differ except for surgical site infection. Given the very low certainty of evidence, these findings are hypothesis-generating and support individualised perioperative management rather than routine restriction of GLP-1 RAs. Level of Evidence Level III (risk/prognostic study).