Work

17 Evaluation of Safety of Preoperative GLP-1 Receptor Agonists in Patients Undergoingelective Surgery: A Systematic Review, Meta-Analysis and Meta-Regression

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background This study aimed to assess the safety and efficacy of preoperative GLP-1 therapy in elective surgical systems. Method 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 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. A Bayesian hierarchical meta-regression was used to explore effect modifiers on the primary outcome. This study is registered with PROSPERO, CRD420251027809. Findings 21 studies (n=97,059 patients) were included; 31.9% (n=30,981) received preoperative GLP-1 therapy. Most studies were single-centre observational cohorts from high-income countries, with no randomised trials identified. Postoperative complications were reported in 12 studies, with no evidence of increased risk from GLP-1 (pooled odds ratio: 0.78, 95% confidence interval: 0.59-1.05). Bayesian meta-analysis yielded consistent findings (posterior mean OR: 0.78; 95% credible interval: 0.57-1.12). Meta-regression identified no statistically significant modifiers of treatment effect to explain heterogeneity. Overall GRADE assessment for evidence certainty was very low. 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. Prioritisation of robust randomised trials by funders and policymakers are needed as part of broader health policy agendas to improve population health and health system resilience.

Source: EClinicalMedicine

DOI: 10.1016/j.eclinm.2025.103408

Authors: Sivesh K. Kamarajah, Nadia Gudiozzi, John M. Findlay, Matthew J. Lee, Thomas Pinkney, Sheraz R. Markar