GLP-1 receptor agonists and surgical care: implications for bariatric Procedures, perioperative Outcomes, and...

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for obesity and type 2 diabetes and are now frequently encountered in patients undergoing bariatric and other elective surgeries. Their effects on gastric motility, appetite, and nutrient intake have important implications for perioperative safety, surgical outcomes, and nutritional care.

To summarize current evidence on the effects of GLP-1RAs on perioperative management, bariatric surgery outcomes, and nutritional optimization in surgical patients.

A narrative review of PubMed- and Scopus-indexed randomized trials, observational studies, systematic reviews, and clinical guidelines was conducted. Evidence was synthesized across perioperative risk, preoperative optimization, post-bariatric outcomes, and nutritional implications.

GLP-1RA use was associated with delayed gastric emptying and increased residual gastric contents in some patients, especially during dose escalation or in those with gastrointestinal symptoms. However, clinically significant aspiration events were uncommon, supporting individualized perioperative management rather than routine discontinuation. Preoperatively, GLP-1RAs promoted short-term weight loss and metabolic improvement in bariatric candidates, potentially improving operative conditions and reducing risk. Postoperatively, the strongest evidence from randomized controlled trials showed that liraglutide and semaglutide achieved additional weight loss and improved glycemic control in patients with weight regain, insufficient weight loss, or persistent diabetes after bariatric surgery, potentially lowering the need for revisional procedures. Nutritionally, appetite suppression may worsen inadequate protein intake and micronutrient deficiencies, increasing risks of sarcopenia, anemia, and bone disease without structured monitoring and supplementation. However, direct trial evidence for supplementation strategies in this specific population is lacking.

GLP-1RAs offer important metabolic and weight-related benefits across the surgical continuum, particularly around bariatric surgery, but require individualized perioperative planning and proactive nutritional surveillance. They should be viewed as adjuncts to, not replacements for, bariatric surgery.