Active GLP-1 RA Use Is Associated With Lower Rates of Surgical Complications Across Diabetic BMI Cohorts

Background Glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is rapidly expanding for diabetes and weight loss. However, limited research exists regarding its effect on postoperative surgical outcomes, particularly in higher-risk patients with comorbidities such as diabetes and obesity. We sought to analyze the effect of GLP-1 RA use on postoperative complications in diabetic patients stratified by BMI. Methods A retrospective, observational cohort analysis was conducted in all patients diagnosed with type 1 or type 2 diabetes mellitus undergoing a surgical procedure between February 2020 to July 2023 at a multicenter quaternary-care health care system. Patients with and without an active GLP-1 RA prescription were compared in each of 4 cohorts: normal weight (BMI 18.5–24.9 kg/m 2 ), overweight (25–29.9), obese (30–40), and morbidly obese (>40). Outcomes examined were dehiscence, infection, hematoma, and bleeding within 180 days after surgery, and 30-day readmission. Results From 72,578 procedures in 21,544 diabetic patients, 23% of patients were classified as normal weight, 34% overweight, 35% obese, and 8% morbidly obese, with active GLP-1 RA use in 15.4%, 24.4%, 33.8%, and 46.5%, respectively. Mean A1C of GLP-1 RA users was significantly higher than nonusers in all cohorts. Active GLP-1 RA cohorts demonstrated a significantly reduced relative risk of postoperative wound dehiscence in normal-weight (0.59), overweight (0.60), obese (0.67), and morbidly obese (0.40) cohorts; a significantly reduced risk of readmission in all cohorts (0.74, 0.82, 0.62, 0.55, respectively); and a significantly reduced risk of postoperative hematoma in obese patients (0.19). Conclusion Active perioperative GLP-1 RA use was associated with significant reductions in readmission and wound dehiscence in diabetic patients across weight categories, despite higher A1C levels, with the greatest reductions in morbidly obese patients. These findings suggest a potential wound healing benefit, with promising implications for diabetic and obese/overweight patients.