Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression
Abstract
Summary 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 In this systematic review and meta-analysis, we systematically searched PubMed, MEDLINE, Embase, and the Cochrane Library from database inception to March 31, 2025, for studies evaluating preoperative GLP-1 RA use in adults undergoing elective surgery, with no language restriction. The primary outcome was perioperative safety, defined as any complication within 90 days after surgery. The secondary outcome was preoperative weight loss. Both frequentist and Bayesian random-effects meta-analyses were conducted. A Bayesian hierarchical meta-regression was used to explore effect modifiers on the primary outcome. A risk-of-bias and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment were done to determine the certainty of the evidence. Final GRADE judgements were made by two independent reviewers, with consensus reached through discussion. Between-study…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 97,059 participants or records.
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