Preoperative GLP-1 receptor agonist use showed no signal of increased surgical complications across 97,059 patients in 21 studies, while achieving meaningful pre-surgery weight loss of up to 16.7 kg.
No increased surgical risk (OR 0.78)Across 97,059 patients in 21 studies, preoperative GLP-1RA use showed a non-significant trend toward fewer — not more — perioperative complications
What the researchers found
Among 97,059 patients across 21 studies (30,981 received preoperative GLP-1RA), postoperative complications showed no increased risk in GLP-1 users (pooled OR: 0.78, 95% CI: 0.59-1.05). Bayesian meta-analysis confirmed this (posterior mean OR: 0.78, 95% credible interval: 0.57-1.12). Meta-regression found no significant effect modifiers. Preoperative weight loss of up to 16.7 kg or 6.0 kg/m² was reported over six months. Overall GRADE certainty of evidence was very low due to observational designs and high heterogeneity (I²=73%).
Why it matters
Anesthesiologists have raised concerns about GLP-1 drugs delaying gastric emptying, potentially increasing aspiration risk during surgery. Some guidelines have recommended holding these drugs before elective procedures. This comprehensive meta-analysis — the largest to date — provides evidence that preoperative GLP-1RA use does not increase overall surgical complications, which could change perioperative management guidelines and support continued or initiated GLP-1RA use for surgical optimization.
How the study worked
Systematic review and meta-analysis (PROSPERO registered) searching PubMed, MEDLINE, Embase, and Cochrane Library through March 2025. 21 studies meeting inclusion criteria were analyzed using both frequentist and Bayesian random-effects meta-analyses. Primary outcome was 90-day perioperative complications; secondary outcome was preoperative weight loss. GRADE assessment evaluated evidence certainty. Bayesian hierarchical meta-regression explored effect modifiers.
What this study cannot tell us
All 21 studies were observational — no randomized trials exist. The GRADE certainty was very low. High heterogeneity (I²=73%) suggests substantial variability across studies that meta-regression could not explain. Most studies were single-center from high-income countries, limiting generalizability. The specific concern about aspiration risk during anesthesia was not separately assessed. Publication bias cannot be excluded. The pooled OR of 0.78 did not reach statistical significance.
How to read the evidence
The authors' own GRADE assessment rated the evidence as very low certainty. While the pooled sample size is large (97,059), all contributing studies were observational with risk of bias, and heterogeneity was substantial. The absence of any randomized trials is a critical limitation.
When this study was published
Published in 2025 in EClinicalMedicine (Lancet group), this meta-analysis is the most comprehensive assessment of perioperative GLP-1RA safety to date, directly addressing a current clinical controversy.
The bigger picture
With obesity reaching epidemic proportions and surgical waitlists growing globally, the potential to use GLP-1 drugs for preoperative optimization is enormous. If these drugs can safely reduce weight before surgery — potentially lowering surgical complications, improving recovery, and enabling patients previously deemed too high-risk for procedures — the impact on healthcare systems could be transformative. This meta-analysis provides the best available evidence supporting this approach, while correctly highlighting the urgent need for randomized trials.
Questions still open
- Should current guidelines recommending GLP-1RA cessation before surgery be revised based on this evidence?
- Is the non-significant trend toward fewer complications (OR 0.78) a real protective effect of preoperative weight loss?
- Do specific surgical types (bariatric, orthopedic, cardiac) show different safety profiles with preoperative GLP-1RA use?
Common questions
Should I stop taking Ozempic before surgery?
Could GLP-1 drugs help patients prepare for surgery?
Read the original research
Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression.
EClinicalMedicine, 87, 103408
Citation
Kamarajah, Sivesh K; Gudiozzi, Nadia; Findlay, John M; Lee, Matthew J; Pinkney, Thomas; Markar, Sheraz R. (2025). Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression.. EClinicalMedicine, 87, 103408. https://doi.org/10.1016/j.eclinm.2025.103408