Prior GLP-1RA or Tirzepatide Use and Early Cardiorenal Outcomes After Metabolic and Bariatric Surgery

To compare early postoperative cardiovascular and kidney outcomes after metabolic and bariatric surgery (MBS) according to prior glucagon-like peptide-1 receptor agonist (GLP-1RA) or tirzepatide use.

This retrospective cohort study used the US Medical Records Database. Adults undergoing MBS from 2016 through 2025 were included. Prior use was defined by at least 1 GLP-1RA or tirzepatide prescription from 365 to 7 days before MBS; patients with prescriptions closer to surgery were excluded. Prior users and nonusers were propensity score matched 1:1. The primary outcome was 4-point major adverse cardiovascular events (MACE), and a key secondary outcome was early postoperative kidney events, assessed from postoperative day 1 through day 90.

After matching, each group included 11,052 patients, with well-balanced baseline characteristics. Prior use was associated with lower risks of 4-point MACE (36 patients [0.3%] vs 67 patients [0.6%]; hazard ratio [HR], 0.535; 95% CI, 0.357-0.803) and early postoperative kidney events (158 patients [1.4%] vs 256 patients [2.3%]; HR, 0.613; 95% CI, 0.502-0.747). Prior GLP-1RA or tirzepatide use was also associated with lower risks of coronary events and heart failure.

Among adults undergoing MBS, prior GLP-1RA or tirzepatide use was associated with lower 90-day risks of 4-point MACE and early postoperative kidney events. These findings support further investigation of preoperative metabolic optimization strategies and their potential role in improving postoperative cardiorenal outcomes.