Metabolic bariatric surgery was linked to larger reductions and lower postoperative complication odds than GLP-1 receptor agonist treatment before general surgery.
Evidence
This Epic Cosmos observational cohort study used entropy balancing and regression in 9470 general surgery patients exposed to or metabolic bariatric surgery 1-3 years before operation.
Caveat
The comparison was not randomized, patients started with higher BMIs, and outcomes were not evaluated against a no-intervention group.
Simplified
Obesity and T2DM substantially increase postoperative risk, with higher surgical site infections in obesity and up to a 65% increase in overall complications in T2DM. This study assesses the impact of weight loss interventions-metabolic bariatric surgery () and glucagon-like peptide-1 receptor agonists ()-on reduction and how that translates to postoperative outcomes in general surgery patients. Patients undergoing general surgery (2016-2024) were identified in the Epic Cosmos database. GLP-1RA or MBS exposure occurred 1-3 years preoperatively (GLP-1RA coverage ≥ 80%). Entropy balancing produced weighted cohorts with similar baseline profiles, followed by multivariable regression models assessing the association between weight loss intervention and BMI change, and the impact of BMI on postoperative outcomes. Overall 9470 individuals underwent a general surgery procedure. Median patient age was 64, with mostly females (60.6%). More patients received GLP-1RA (n = 7823, 82.3%) than MBS (n = 1647, 17.4%). MBS patients had higher initial BMIs (≥ 40: 60.8% vs. 24.5%, p < 0.001). MBS led to greater BMI reduction than GLP-1RA (Mean difference: -9.89, 95% CI: -9.64, -10.34). Higher BMI at time of a general surgical procedure correlated with increased postoperative complications (OR: 1.01, 95% CI: 1.00-1.01) and extended LOS (OR: 1.01, 95% CI: 1.00-1.01). MBS was associated with lower complication odds (OR: 0.87, 95% CI: 0.78-0.98). MBS improved surgical outcomes in patients with obesity and T2DM through greater BMI reduction compared with GLP-1RAs. These findings support the role of preoperative weight loss to mitigate surgical risk; however, evaluating outcomes relative to no intervention remains an important future direction.
Key numbers
-9.89
Mean Reduction
Difference in reduction between and treatments.
1.01
Complication Odds Ratio
Odds ratio for complications per 1 unit increase in at surgery.
0.87
Lower Complication Odds with
Odds ratio for complications in patients with prior compared to .
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