ArticleObesity surgery2026
Preoperative GLP-1 Receptor Agonist (GLP-1 RA) Exposure Is Associated With Postoperative Initiation of GLP-1 RA Following Metabolic Bariatric Surgery: A Multicenter Cohort Study.
Article in Obesity surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundA substantial proportion of patients undergoing metabolic bariatric surgery (MBS) receive adjunctive pharmacotherapy for suboptimal weight outcomes. Preoperative glucagon-like peptide-1 receptor agonist (GLP-1 RA) exposure may characterize a treatment-resistant subgroup, yet postoperative pharmacotherapy patterns in this population remain poorly understood.
methodsThis multicenter retrospective cohort study used the TriNetX database to identify adults undergoing MBS, comparing patients with and without preoperative GLP-1 RA exposure using 1:1 propensity score matching. The primary outcome was GLP-1 RA initiation occurring one–two years after surgery. The secondary outcomes included suboptimal glycemic control (HbA1c ≥ 7%), suboptimal weight control (body mass index ≥ 35 kg/m2), hospitalization, and emergency department (ED) visits.
resultsIn the propensity score–matched cohorts (n = 2,811 per group), patients with preoperative GLP-1 RA exposure demonstrated a higher observed rate of postoperative GLP-1 RA initiation than controls (15.3% vs. 7.6%; hazard ratio [HR]: 2.14, 95% confidence interval[CI]:1.81–2.52, p < 0.001). Suboptimal weight control was more prevalent in the exposure group (HR:1.18, p = 0.014), while suboptimal glycemic control, hospitalization, and ED visits showed no significant differences. Similar patterns were observed across surgical subtypes and age groups.
conclusionPreoperative GLP-1 RA exposure was associated with a higher likelihood of postoperative GLP-1 RA initiation following MBS. Rather than reflecting a causal effect, this association likely identifies a distinct patient phenotype characterized by greater treatment complexity and a higher likelihood of requiring ongoing multimodal weight management after surgery.
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