CoChat
Sign Up
Cited by 29Diabetes Treatment and ManagementCardiac, Anesthesia and Surgical OutcomesHyperglycemia and glycemic control in critically ill and hospitalized patients

Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression

Open access
Kamarajah, Sivesh K., Gudiozzi, Nadia, Findlay, John M., Lee, Matthew J., Pinkney, Thomas, Markar, Sheraz R.·2025·eClinicalMedicine
DOI 10.1016/j.eclinm.2025.103408PMC PMC12496209
Open this paper in CoChat — free account

Abstract

Abstract Background This study aimed to assess the safety and efficacy of preoperative GLP-1 therapy in elective surgical systems. Method In this systematic review and meta-analysis, we systematically searched PubMed, MEDLINE, Embase, and the Cochrane Library from database inception to March 31, 2025, for studies evaluating preoperative GLP-1 use in adults undergoing elective surgery, with no language restriction. The primary outcome was perioperative safety, defined as any complication within 90 days after surgery. A Bayesian hierarchical meta-regression was used to explore effect modifiers on the primary outcome. This study is registered with PROSPERO, CRD420251027809. Findings 21 studies (n=97,059 patients) were included; 31.9% (n=30,981) received preoperative GLP-1 therapy. Most studies were single-centre observational cohorts from high-income countries, with no randomised trials identified. Postoperative complications were reported in 12 studies, with no evidence of increased risk from GLP-1 (pooled odds ratio: 0.78, 95% confidence interval: 0.59-1.05). Bayesian meta-analysis yielded consistent findings (posterior mean OR: 0.78; 95% credible interval: 0.57-1.12). Meta-regression identified no statistically significant modifiers of treatment effect to explain heterogeneity. Overall GRADE assessment for evidence certainty was very low. Interpretation Preoperative GLP-1 RA therapy may support clinically meaningful weight loss without a clear signal of increased perioperative risk, offering a potentially scalable strategy for surgical optimisation. However, the certainty of current evidence is very low, with most studies observational in design and at risk of bias. Prioritisation of robust randomised trials by funders and policymakers are needed as part of broader health policy agendas to improve population health and health system resilience.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis of 21 studies and 97,059 patients found no clear signal of increased perioperative complications with preoperative GLP-1 receptor agonist use, with a pooled odds ratio of 0.78 (95% CI 0.59–1.05). Preoperative GLP-1 RA use was associated with clinically meaningful weight loss, but the certainty of evidence was very low and most data were observational.

Key findings

  • Among 21 included studies, 31.9% (n = 30,981) of 97,059 patients received preoperative GLP-1 RA therapy; most studies were single-centre observational cohorts from high-income countries.
  • For postoperative complications, the frequentist random-effects pooled OR was 0.78 (95% CI 0.59–1.05), with high heterogeneity (I² = 73%); the Bayesian sensitivity analysis was reported as consistent (abstract: posterior mean OR 0.78, 95% CrI 0.57–1.12; results text: posterior mean log OR 0.86, 95% CrI 0.61–1.22).
  • Meta-regression found no statistically significant modifiers of treatment effect; the overall GRADE certainty of evidence for postoperative complications was very low.
  • In studies reporting weight loss, preoperative GLP-1 RA use was associated with weight loss of up to 16.7 kg or 6.0 kg/m² over six months, and up to 17% excess body weight loss over 52 weeks.

Methods

  • Systematic review and meta-analysis registered with PROSPERO (CRD420251027809), searching PubMed, MEDLINE, Embase, and the Cochrane Library from database inception to March 31, 2025, for studies of preoperative GLP-1 RA in adults undergoing elective surgery.
  • Primary outcome was perioperative safety, defined as any postoperative complication within 90 days of surgery; secondary outcomes included preoperative weight loss and GLP-1-specific adverse events.
  • Frequentist random-effects meta-analysis using REML and Bayesian random-effects meta-analysis were performed, plus Bayesian hierarchical meta-regression with age, female proportion, BMI, and diabetes proportion as modifiers and a country-level random intercept; risk of bias was assessed with ROBINS-I and RoB-2, and GRADE was used for certainty.

Limitations

  • The paper states heterogeneity of study designs, populations, and outcome measures limited direct comparisons; weight-loss assessment methods and definitions of postoperative complications were inconsistent, and preoperative GLP-1 protocols were not standardised.
  • The paper states most studies did not clearly report whether GLP-1 RA therapy was discontinued at surgery or continued postoperatively; newer agents such as tirzepatide were understudied; publication bias was possible; and findings may not generalise to low- and middle-income settings.
  • The text also makes evident internal inconsistencies: the abstract states no randomised trials were identified, while the Results describe two multicentre randomised controlled trials and the risk-of-bias section refers to one included randomised trial; the abstract describes complications within 90 days, while the Results state twelve studies reported complications within 30 days.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.eclinm.2025.103408

Cites

61 of 61 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 35 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There was no evidence of increased risk of postoperative complications in GLP-1 users.

    “with no evidence of increased risk in GLP-1 users”
    • Also stated in: § Funding · plain
      “without evidence of adverse perioperative outcomes”
    Quote in the paperSubstantial claim
  • Findingown data

    No prior systematic review or meta-analysis had comprehensively examined whether GLP-1 therapy could be safely integrated into preoperative pathways.

    “We identified no prior systematic review, or meta-analysis had comprehensively examined whether GLP-1 therapy could be safely integrated into preoperative pathways, revealing a critical knowledge gap.”
    Quote in the paperSubstantial claim
  • Findingown data

    Meta-regression identified no statistically significant modifiers of treatment effect to explain the heterogeneity.

    “Meta-regression identified no statistically significant modifiers of treatment effect to explain the heterogeneity.”
    Quote in the paperNot a substantial claim
  • Findingown data

    31.9% (n = 30,981) of included patients received preoperative GLP-1 RA therapy.

    “31.9% (n = 30,981) received preoperative GLP-1 RA therapy”
    • Also stated in: § Patient characteristics · plain
      “of which 31.9% (n = 30,981) received preoperative GLP-1”
    Quote in the paperNot a substantial claim
  • Findingreasoning

    Most included studies were at risk of bias.

    “and at risk of bias”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 36
  • May combine two claims. 26
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 18 comparative studies, two were multicentre randomised controlled trials.

    “Of the remaining 18 studies, two were multicentre randomised controlled trials”
    • Also stated in: § Study characteristics · plain
      “For the two randomised controlled trials, both were comparing GLP-1 receptor agonists (vs. placebo or standard of care).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Publication bias was not detected on funnel plot or Egger's test.

    “Publication bias was not detected on funnel plot or Egger's test (Appendix p 10; Figure S1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 21 studies identified, twelve studies reported postoperative complications within 30 days from surgery.

    “Of the 21 studies identified, twelve studies reported postoperative complications within 30-days from surgery.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Age, BMI, and proportion female showed no directional association with treatment effect.

    “Age, BMI, and proportion female showed no directional association.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Reporting of weight loss varied across studies.

    “though reporting varied across studies”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The three studies reporting a change in body weight reported a reduction of weight up to 16.7 kg over six months, but the type of GLP-1 remains unclear.

    “The three studies reporting a change in body weight reported a reduction of weight up to 16.7 kg over six months, but the type of GLP-1 remains unclear.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The current evidence base is predominantly observational, with little standardisation in safety reporting.

    “However, the current evidence base is predominantly observational, with little standardisation in safety reporting.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Postoperative complications were reported in 12 studies.

    “Postoperative complications were reported in 12 studies”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Ten studies reported evaluation of preoperative weight loss before surgery using three measures: absolute body weight (n = 2), change in absolute body weight (n = 4), and proportion of excess body weight loss (n = 3) up to 52 weeks.

    “Ten studies reported evaluation of preoperative weight loss before surgery using three different measures: (i) absolute body weight (n = 2); (ii) change in absolute body weight (n = 4); and (iii) proportion of excess body weight loss (n = 3) up to 52 weeks.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The four studies reporting proportion of excess body weight loss reported a reduction in weight up to 17%, with a preoperative treatment duration of 52 weeks.

    “The four studies reporting proportion of excess body weight loss reported a reduction in weight up to 17%, but a preoperative treatment duration of 52 weeks.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most included studies were observational, single-centre cohorts from high-income countries.

    “Most studies were single-centre observational cohorts from high-income countries”
    • Also stated in: § Study characteristics · plain
      “The majority (n = 18/21, 85.7%) were published from high income countries”
    • Also stated in: § Interpretation · plain
      “with most studies observational in design”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    The systematic review included 21 studies comprising 97,059 patients undergoing elective surgery.

    “A total of 21 studies, comprising 97,059 patients, met inclusion criteria”
    • Also stated in: § Literature search · plain
      “Finally, 21 studies22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 were included that met the inclusion criteria”
    • Also stated in: § Patient characteristics · plain
      “This scoping review included 97,059 patients”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In a frequentist random-effects model, the pooled odds ratio for postoperative complications with preoperative GLP-1 receptor agonist use was 0.78 (95% CI 0.59-1.05), with high between-study heterogeneity (I2 = 73.0%).

    “In a frequentist random-effects model, the pooled OR was 0.78 (95% CI: 0.59–1.05), with high between-study heterogeneity (I2 = 73.0%) (Fig. 2A).”
    • Also stated in: § Postoperative complications · hedged
      “Although the pooled OR suggested a potential protective effect (OR 0.78 [95% CI: 0.59–1.05]), this result was imprecise and heterogeneous.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Most included studies were observational and at moderate to serious risk of bias.

    “Most included studies were observational and at moderate to serious risk of bias (Fig. 3, Appendix p 7–9).”
    • Also stated in: § Discussion · plain
      “with most studies observational in design and at risk of bias.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only one study reported aspiration pneumonia, and it showed no significant difference between patients with and without preoperative GLP-1 use.

    “Only one study reported aspiration pneumonia, which showed no significant difference between patients with and without use of pre-operative GLP-1.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    There were variable definitions used for adverse events.

    “There were variable definitions used for adverse events.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In a hierarchical Bayesian meta-regression including four pre-specified study-level modifiers and a country-level random intercept, no covariate showed a statistically meaningful association with treatment effect; all credible intervals included the null and effect sizes were small.

    “Posterior mean estimates and 95% CrIs for each covariate indicated no statistically meaningful associations with treatment effect. All CrIs included the null, and effect sizes were small in magnitude.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Few studies to date have examined the perioperative safety profiles of newer agents such as tirzepatide, which may differ from liraglutide or semaglutide.

    “However, few studies to date have examined the perioperative safety profiles of these newer agents, which may differ from liraglutide or semaglutide.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    This study highlights crucial gaps in the literature, particularly the lack of randomised controlled trials.

    “Additionally, this study highlights crucial gaps in the literature, particularly the lack of randomised controlled trials, emphasising the need for more rigorous investigations to establish definitive clinical recommendations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    This review identified two studies that evaluated the impact of GLP-1 therapy on glycaemic control in surgical patients, and heterogeneity in study designs limits definitive conclusions.

    “This review identified two studies that evaluated the impact of GLP-1 therapy on glycaemic control in surgical patients, yet the heterogeneity in study designs limits definitive conclusions.10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Yao, 2024, Comparative effectiveness of GLP-1 receptor agonists on glycaemic control, body weight, and lipid profile for type 2 diabetes: systematic review and network meta-analysis, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Publication bias and small study effects were assessed using visual inspection of funnel plots and Egger's test.

    “Potential publication bias and small study effects were assessed using visual inspection of funnel plots and Egger's test.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Study screening was performed by two independent reviewers.

    “The study screening was delivered over a two-staged process by two independent reviewers (SKK, NG).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    There remains a clinical need for effective, scalable, and preoperatively applicable strategies for weight loss in surgical patients.

    “Therefore, there remains a clinical need for effective, scalable, and preoperatively applicable strategies.14,15”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] Shahid, 2025, Comparison of weight loss interventions in overweight and obese adults with knee osteoarthritis: a systematic review and network meta-analysis of randomized trials, Osteoarthritis Cartilage source

      Not checked in the free run.

    • cites [15] Zhang, 2024, A scoping review of preoperative weight loss interventions on postoperative outcomes for patients with gastrointestinal cancer, Eur J Surg Oncol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review was reported according to PRISMA guidelines.

    “reported according to the Preferred Extension for Systematic Review (PRISMA)16 guidelines”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Page, 2021, The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, Int J Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Data extraction was performed independently by two reviewers.

    “Two reviewers (SKK, NG) independently performed data extraction, and discrepancies were resolved by consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is supportive evidence that weight loss prior to surgery has benefits.

    “There is supportive evidence supporting the benefits of weight loss prior to surgery.51,52”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [51] Cassie, 2011, Effect of preoperative weight loss in bariatric surgical patients: a systematic review, Surg Obes Relat Dis source

      Not checked in the free run.

    • cites [52] Shul, 2024, The impact of preoperative weight loss timing on surgical outcomes in total hip arthroplasty, J Arthroplasty source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Risk of bias was evaluated using ROBINS-I for observational studies and RoB-2 for the one included randomised trial.

    “Risk of bias was evaluated using the ROBINS-I tool for observational studies and RoB-2 for the one included randomised trial”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Final GRADE judgements were made by two independent reviewers with consensus.

    “Final GRADE judgements were made by two independent reviewers, with consensus reached through discussion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Non-informative (flat) priors were used for all parameters in Bayesian models to minimise the influence of prior assumptions.

    “Non-informative (flat) priors were used for all parameters to minimise the influence of prior assumptions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Preoperative weight loss has been associated with improved intraoperative technical performance, enhanced visualisation, and reduced operative time.

    “Preoperative weight loss has been associated with improved intraoperative technical performance, enhanced visualisation, and reduced operative time.52,53”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [52] Shul, 2024, The impact of preoperative weight loss timing on surgical outcomes in total hip arthroplasty, J Arthroplasty source

      Not checked in the free run.

    • cites [53] Pavlovic, 2021, Effect of weight-loss diets prior to elective surgery on postoperative outcomes in obesity: a systematic review and meta-analysis, Clin Obes source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Meta-regression modifiers (mean age, proportion female, mean BMI, proportion diabetes) were selected a priori based on clinical relevance.

    “These variables were selected a priori based on clinical relevance across published studies.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    There remains a knowledge gap regarding the safety and weight loss profiles of GLP-1 RAs in patients undergoing surgery.

    “Despite this, there remains a knowledge gap regarding the safety and weight loss profiles in patients undergoing surgery.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    There is potential variation in effect size by country, and the lower credible bound above zero supports the possibility of meaningful contextual heterogeneity.

    “indicating potential variation in effect size by country. Although the credible interval was wide, the lower bound above zero supports the possibility of meaningful contextual heterogeneity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review was conducted according to the Cochrane Training for Systematic Reviews.

    “This scoping review was conducted according to the Cochrane Training for Systematic Reviews.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In people using GLP-1 RAs long-term, there is less certainty about the risk of pulmonary aspiration, particularly because the effect of tachyphylaxis on gastric emptying is unclear.

    “In people using GLP-1 RAs long-term,48 there is less certainty in regard to the risk of pulmonary aspiration,49 particularly because the effect of tachyphylaxis on gastric emptying is unclear.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [48] Yeo, 2024, Increased risk of aspiration pneumonia associated with endoscopic procedures among patients with glucagon-like peptide 1 receptor agonist use, Gastroenterology source

      Not checked in the free run.

    • cites [49] Klonoff, 2024, Risks of peri- and postoperative complications with glucagon-like peptide-1 receptor agonists, Diabetes Obes Metab source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    GLP-1 receptor agonists such as liraglutide and semaglutide have demonstrated efficacy in weight loss.

    “Pharmacological agents such as liraglutide and semaglutide have demonstrated efficacy in weight loss,10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Yao, 2024, Comparative effectiveness of GLP-1 receptor agonists on glycaemic control, body weight, and lipid profile for type 2 diabetes: systematic review and network meta-analysis, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Preoperative GLP-1 RA therapy may support clinically meaningful weight loss without a clear signal of increased perioperative risk, offering a potentially scalable strategy for surgical optimisation.

    “Preoperative GLP-1 RA therapy may support clinically meaningful weight loss without a clear signal of increased perioperative risk, offering a potentially scalable strategy for surgical optimisation.”
    • Also stated in: § Discussion · hedged
      “Preoperative GLP-1 RA therapy may support clinically meaningful weight loss without a clear signal of increased perioperative risk, offering a potentially scalable strategy for surgical optimisation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The review was prospectively registered with PROSPERO (CRD420251027809).

    “This was a prospectively registered systematic review (PROSPERO: CRD420251027809)”
    • Also stated in: § Methods · plain
      “This study is registered with PROSPERO, CRD420251027809.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Convergence was assessed using trace plots and the Gelman-Rubin diagnostic statistic.

    “Convergence was assessed using trace plots and the Gelman–Rubin diagnostic statistic.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Clavien-Dindo classification is a widely adopted and validated system for grading the severity of complications.

    “This classification is a widely adopted and validated system that grades the severity of complications based on the type of therapeutic intervention required.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] Clavien, 2009, The Clavien-Dindo classification of surgical complications: five-year experience, Ann Surg source

      Not checked in the free run.

    • cites [20] Dindo, 2003, Obesity in general elective surgery, Lancet source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Certainty of evidence was assessed using the GRADE approach.

    “We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Excess adiposity is associated with increased perioperative risk, including anaesthetic complications, delayed wound healing, increased infection rates, and prolonged hospital stays.

    “Excess adiposity is associated with increased perioperative risk, including anaesthetic complications, delayed wound healing, increased infection rates, and prolonged hospital stays.13”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Simillis, 2022, A systematic review and meta-analysis assessing the impact of body mass index on long-term survival outcomes after surgery for colorectal cancer, Eur J Cancer source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    GLP-1 therapy improves glycaemic control, reduces insulin resistance, and lowers cardiovascular risk factors.

    “Research evidence demonstrates that GLP-1 therapy improves glycaemic control, reduces insulin resistance, and lowers cardiovascular risk factors.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Lingvay, 2024, Obesity in adults, Lancet source

      Not checked in the free run.

    • cites [6] Brindal, 2017, Weight management programmes of extended duration, Lancet source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The observed outcomes may reflect effects of continued perioperative GLP-1 RA use rather than strictly preoperative administration.

    “which raises the possibility that observed outcomes may reflect effects of continued perioperative use rather than strictly preoperative administration.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Supervised exercise regimens and behavioural modification programmes have been proposed as adjuncts to optimise weight loss and physical conditioning before surgery.

    “Second, supervised exercise regimens and behavioural modification programmes have been proposed as adjuncts to optimise weight loss and physical conditioning before surgery.56”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Fong, 2023, The effect of preoperative behaviour change interventions on pre- and post-surgery health behaviours, health outcomes, and health inequalities in adults: a systematic review and meta-analyses, PLoS One source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Very low-calorie diets have shown promise in improving liver size and metabolic parameters preoperatively, which may enhance surgical safety and recovery.

    “VLCDs have shown promise in improving liver size and metabolic parameters preoperatively, which may enhance surgical safety and recovery.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [51] Cassie, 2011, Effect of preoperative weight loss in bariatric surgical patients: a systematic review, Surg Obes Relat Dis source

      Not checked in the free run.

    • cites [55] Kauppila, 2019, Effects of obesity surgery on overall and disease-specific mortality in a 5-country population-based study, Gastroenterology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    GLP-1 RA offer significant metabolic benefits, particularly in patients with type 2 diabetes.

    “Beyond weight loss, GLP-1 RA offer significant metabolic benefits, particularly in patients with type 2 diabetes.6,9”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Brindal, 2017, Weight management programmes of extended duration, Lancet source

      Not checked in the free run.

    • cites [9] 2025, The era of GLP-1 receptor agonists: costs versus benefits, Lancet Diabetes Endocrinol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Evidence from bariatric surgery cohorts suggests that weight loss before surgery is linked to better long-term outcomes, including lower postoperative complication rates, improved weight maintenance, and enhanced metabolic control.

    “Further, evidence from bariatric surgery cohorts suggests that weight loss before surgery is linked to better long-term outcomes, including lower postoperative complication rates, improved weight maintenance, and enhanced metabolic control.53,54”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [53] Pavlovic, 2021, Effect of weight-loss diets prior to elective surgery on postoperative outcomes in obesity: a systematic review and meta-analysis, Clin Obes source

      Not checked in the free run.

    • cites [54] Saleh, 2024, Impact of preoperative weight loss on 30-day complication rate after bariatric surgery, J Am Coll Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The STEP trials evaluating semaglutide in non-surgical obesity have demonstrated weight reductions of up to 15% over 68 weeks.

    “For instance, the STEP trials evaluating semaglutide in non-surgical obesity have demonstrated weight reductions of up to 15% over 68 weeks.2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] 2024, Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults, Lancet source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    A multimodal approach combining dietary interventions, structured physical activity, and pharmacological agents such as GLP-1 RA may offer a more effective and scalable strategy for preoperative weight management.

    “Therefore, a multimodal approach combining dietary interventions, structured physical activity, and pharmacological agents such as GLP-1 RA may offer a more effective and scalable strategy for preoperative weight management.59”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Rubino, 2021, Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial, JAMA source

      Not checked in the free run.

    • Rests on an assumption: Current strategies for achieving meaningful preoperative weight loss remain limited.
    • Rests on an assumption: Widespread implementation of preoperative weight-loss strategies across health systems is a challenge due to cost implications and variable adherence in real-world clinical practice.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    As this review relied on published studies, there is a possibility of publication bias, where studies reporting positive outcomes may be overrepresented.

    “Finally, as this review relied on published studies, there is a possibility of publication bias, where studies reporting positive outcomes may be overrepresented.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Randomised controlled trials such as SUSTAIN and LEADER have shown that GLP-1 RA facilitate weight loss and contribute to improved HbA1c levels and reduced incidence of major adverse cardiovascular events.

    “Randomised controlled trials such as the SUSTAIN and LEADER trials have shown that GLP-1 RA not only facilitate weight loss but also contribute to improved HbA1c levels and reduced incidence of major adverse cardiovascular events.5,6”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Lingvay, 2024, Obesity in adults, Lancet source

      Not checked in the free run.

    • cites [6] Brindal, 2017, Weight management programmes of extended duration, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The findings from this review suggest that similar magnitudes of weight loss may be achievable in the preoperative period, though further prospective studies are required to confirm clinical benefits in surgical patients.

    “The findings from this review suggest that similar magnitudes of weight loss may be achievable in the preoperative period, though further prospective studies are required to confirm the clinical benefits in surgical patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prehabilitation programmes incorporating lifestyle interventions, dietary modifications, and medical therapy have shown promise.

    “Third, prehabilitation programmes incorporating lifestyle interventions, dietary modifications, and medical therapy have shown promise.57,58”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [57] McIsaac, 2025, Relative efficacy of prehabilitation interventions and their components: systematic review with network and component network meta-analyses of randomised controlled trials, BMJ source

      Not checked in the free run.

    • cites [58] Kamarajah, 2020, Critical appraisal on the impact of preoperative rehabilitation and outcomes after major abdominal and cardiothoracic surgery: a systematic review and meta-analysis, Surgery source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    A key strength of this study is its systematic methodology, adherence to a pre-registered protocol, formal risk-of-bias assessments, and use of GRADE to evaluate certainty of evidence.

    “A key strength of this study is the systematic methodology employed, adherence to a pre-registered protocol, formal risk-of-bias assessments, and the use of GRADE to evaluate certainty of evidence on GLP-1 on postoperative complications.”
    Quote in the paperSubstantial claim
55 of 55

  • The paper relies on this without support.

    The absence of a statistically significant increase in postoperative complications in pooled observational data indicates no clinically important increased perioperative risk.

    “with no evidence of increased risk in GLP-1 users”
    “without a clear signal of increased perioperative risk”

  • The paper relies on this without support.

    Weight loss of up to 16.7 kg or 6.0 kg/m2 over six months is clinically meaningful in patients undergoing elective surgery.

    “may support clinically meaningful weight loss”
    “appear to effect clinically meaningful weight loss before elective surgery”

  • The paper relies on this without support.

    Findings from predominantly high-income, observational surgical populations are generalisable to diverse surgical systems.

    “offering a potentially scalable strategy for surgical optimisation”
    “implementation potential across diverse surgical systems”

  • The paper relies on this without support.

    A comprehensive evaluation of the literature on the safety of perioperative GLP-1 was lacking before this review.

    “However, guidelines around this have lacked comprehensive evaluation of the literature on this topic.”
    “To our knowledge, this is the first evaluation summarising the evidence of the safety of preoperative GLP-1 in patients undergoing surgery.”

  • The paper relies on this without support.

    Current strategies for achieving meaningful preoperative weight loss remain limited.

    “Despite these benefits, current strategies for achieving meaningful preoperative weight loss remain limited.”

  • The paper relies on this without support.

    Widespread implementation of preoperative weight-loss strategies across health systems is a challenge due to cost implications and variable adherence in real-world clinical practice.

    “Despite this, widespread implementation across health systems remains a challenge due to cost implications and variable adherence to these programs in real world clinical practice.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting counts of randomised trials

    Major

    The abstract says no randomised trials were identified, whereas the study characteristics report two. The methods also refer to "the one included randomised trial."

  • Diabetes modifier interval does not include the null

    Major

    The reported interval of 1.14-4.08 excludes both 0, the null for a regression coefficient, and 1, the null if these values are ratios. It therefore contradicts the statement that all modifier credible intervals included the null.

  • Bayesian pooled result differs between abstract and results

    Major

    The abstract reports a Bayesian posterior mean OR of 0.78 with a credible interval of 0.57-1.12. The results instead report a posterior mean *log OR* of 0.86 with a credible interval of 0.61-1.22 for the same analysis; those values are neither the same estimate nor equivalent on the odds-ratio scale.

  • Incorrect percentage of recently published studies

    Minor

    Eighteen of 21 studies is 85.7%, not 78.3%.

    Reported 78.3 · recomputed 85.714286

  • Weight-loss study categories total nine, not ten

    Minor

    The three listed category counts sum to nine studies, although the paragraph says ten studies reported preoperative weight loss.

    Reported 10 · recomputed 9

5 of 5

Cites

Flagged first, then by citations

2 of the 63 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Kamarajah, S. K., Gudiozzi, N., Findlay, J. M., Lee, M. J., Pinkney, T., & Markar, S. R.
Affiliations
  • University of Birmingham (GB)
  • Churchill Hospital (GB)
  • University of Exeter (GB)
Corresponding author
Kamarajah, Sivesh K.
ORCID
Venue
eClinicalMedicine
Publisher
Elsevier BV
Published
2025-09
Volume
87
Issue
Supplement_7
Pages
103408
ISSN
2589-5370 (ISSN-L)
DOI
10.1016/j.eclinm.2025.103408
PMC
PMC12496209
OpenAlex
W4413186443
Semantic Scholar
b135b635c75c9bb80febe91406f83fd7e4c3efb4
Cited by
29
References
63
Citations by year
2026: 24 · 2025: 5
FWCI
3.95
Type
journal article
Language
en
Open access
Licence
Locations
  • EClinicalMedicine (publishedVersion, cc-by)
  • British journal of surgery (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • Royal Devon and Exeter Research Repository (Royal Devon and Exeter) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Funders
  • National Institute for Health and Care Research (NIHR303288)
  • NIHR Imperial Biomedical Research Centre
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords
GLP-1 receptor agonists, elective surgery, perioperative safety, postoperative complications, weight loss, effect modifiers

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review