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Published on: June 11, 2012

Preoperative Glucagon-Like Peptide-1 Receptor Agonists and Postoperative Outcomes: An Observational Analysis

Una E Choi1, Ryan C Nicholson2, Chelsea Messinger3

  • 1Mass General Brigham/Brigham and Women's Hospital Harvard Medical School Dept of Anesthesiology 75 Francis St Boston, MA 02115.

Anesthesiology
|August 12, 2026
PubMed
Abstract

Insights

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) use before surgery was linked to lower postoperative mortality compared to metformin and DPP4is. These findings suggest potential perioperative benefits for GLP-1 RAs in type 2 diabetes patients.

Area of Science:

  • Anesthesiology
  • Endocrinology
  • Pharmacology

Background:

  • Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are widely used for type 2 diabetes (T2DM), showing benefits in glycemic control, cardiac health, and weight.
  • The impact of GLP-1 RAs on perioperative outcomes in surgical patients with T2DM requires further investigation.

Purpose of the Study:

  • To evaluate the association between preoperative GLP-1 RA use and short-term postoperative outcomes in adult surgical patients with T2DM.
  • To compare the safety and efficacy of GLP-1 RAs with other common T2DM medications (metformin, SGLT2i, DPP4i) in the perioperative setting.

Main Methods:

  • An observational analysis of electronic health records (TriNetX) from June 2013 to June 2023.
  • Propensity-score matching of adult T2DM surgical patients to compare GLP-1 RA use against metformin, SGLT2 inhibitors (SGLT2i), or DPP-4 inhibitors (DPP4i).
  • Outcomes assessed included 14-day postoperative mortality, aspiration pneumonitis, pneumonia, emergency intubation, acute kidney injury, stroke, myocardial infarction (MI), and major adverse cardiovascular events (MACE).

Main Results:

  • Preoperative GLP-1 RA use was associated with significantly reduced 14-day postoperative mortality compared to metformin (RR 0.44) and DPP4is (RR 0.63).
  • GLP-1 RAs were linked to a lower incidence of bacterial pneumonia compared to DPP4is (RR 0.47).
  • A numerical, but not statistically significant, difference in MACE was observed when comparing GLP-1 RAs to SGLT2is (RR 0.77).

Conclusions:

  • Preoperative GLP-1 RA administration appears associated with improved short-term postoperative outcomes, including reduced mortality and morbidity, when compared to metformin and DPP4is.
  • No increased risk of aspiration pneumonitis was identified with GLP-1 RA use compared to other drug classes.
  • Further prospective studies are warranted to confirm these findings and inform evidence-based perioperative management strategies for T2DM patients using GLP-1 RAs.

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