Perioperative Adverse Events in Women Taking GLP1-RAs in Gynecologic Surgery

INTRODUCTION: Since the approval of semaglutide as a weight loss agent in 2021, there has been an explosive use of glucagon-like peptide 1 receptor agonists (GLP1-RA). This has consequently resulted in the increased use of GLP1-RAs in gynecologic patients undergoing surgery. Due to the increased prevalence of this medication in the gynecologic surgical population, it is important to know if these medications convey an increased risk for surgical complications. OBJECTIVE: To evaluate the rate of perioperative and postoperative adverse events in women undergoing a hysterectomy while taking GLP1-RAs, inclusive of GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonist tirzepitide, compared to women not being treated with GLP1-RAs. METHODS: This is a retrospective case-control study comparing patients undergoing hysterectomy who were taking a GLP1-RA at the time of surgery to women not taking GLP1-RAs. A total of 401 patients who had hysterectomy between January 2022 and December 2024 were identified. The patients on GLP1-RA medications were matched 1:2 to patients not on GLP1-RA medications (control) by route of hysterectomy, age, and BMI. Chart review identified patient characteristics and demographics, operative variables, and postoperative course. Postoperative events prior to discharge and up to 3 months post-op were evaluated using the Clavien–Dindo scale. RESULTS: A total of 133 patients who underwent a hysterectomy while taking a GLP1-RA were identified; these patients were matched to 268 patients who had a hysterectomy. Patients on GLP1-RA medications were less likely to be White (54.4% vs 65.7% p=0.017) and more likely to be a previous tobacco user (33.1% vs 19.8, p=0.013). Patients on a GLP1-RA were more likely to be diabetic (42.1% vs 4.5%, p<0.001). Other demographic characteristics were similar between groups and both groups had similar gynecologic history and surgical history. Operative variables were similar between groups, with no differences between reason for surgery (p=0.746) or surgical route (p=0.934). Patients who underwent an unplanned additional gynecologic procedure during hysterectomy were more frequently in the GLP1-RA group than the control group (22.6% vs 14.6%, p=0.046). Immediate postoperative events classified by Clavien–Dindo scale were similar between groups (p=0.833). Outpatient postoperative complications were similar between groups when classified by Clavien–Dindo scale (p=0.570). When looking specifically at outpatient Grade 3 postoperative complications, patients using GLP1-RAs were less likely to require additional surgical intervention under local anesthesia or under general anesthesia (0 vs 3 local anesthesia, 1 vs 8 general anesthesia, p=0.048). When looking at general resource utilization (additional visits, phone calls) outside of routine postoperative care, patients on GLP1-RAs were more likely to require additional resources when compared to patients not on a GLP1-RA (60.2% vs 46.7%; p=0.019). CONCLUSIONS: We found surgical and recovery outcomes to be similar in women on GLP1-RAs versus not in this large cohort. This should reassure patients and surgeons when managing these medications. Postoperative resource utilization was higher in women on GLP1-RAs, which may be related to hospital protocols managing these medications in the perioperative period.Table 1Table 2