Effects of Preoperative Glucagon-Like Peptide-1 Receptor Agonists on Weight Loss After Bariatric Surgery

Introduction: Despite surging interest in glucagon-like peptide-1 receptor agonist (GLP1RA), there are few data regarding how preoperative GLP1RA impacts postoperative outcomes after bariatric surgery. Methods: This is a retrospective cohort study comparing early and long-term total weight loss (TWL%) between adult patients with and without preoperative GLP1RA before bariatric surgery. Results: A total of 902 patients were included, with 561 (62.2%) patients having gastric bypass and the rest having sleeve gastrectomy. Among these, 19 patients had liraglutide and 10 had semaglutide before surgery. Patients who received GLP1RA experienced slightly greater preoperative weight loss (6.7 ± 7.0% vs. 4.8 ± 9.9%, p = 0.30). A trend toward higher 1- to 2-month weight loss with preop GLP1RA, which was only significant among sleeve gastrectomy patients, was observed, with TWL% being 17.6 ± 7.4% vs. 11.4 ± 6.4% ( p < 0.01) and 21.9 ± 7.6% vs. 17.1 ± 7.0% ( p = 0.03) at 1 and 2 months, respectively. This difference gradually diminished at 6 months (27.5 ± 6.7% vs. 24.3 ± 7.6%, p = 0.15), 1 year (31.8 ± 7.7% vs. 28.3 ± 9.5%, p = 0.23), and 2 years (30.2 ± 8.2% vs. 28.2 ± 10.3%, p = 0.23). Conclusions: Greater early weight loss after sleeve gastrectomy was observed among patients who had preoperative GLP1RA. It is worth considering continuing GLP1RA after sleeve gastrectomy for patients who are at high risk for insufficient weight loss.