GLP-1 receptor agonists necessitate individualized perioperative management and nutritional strategies in surgical patients.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for obesity and type 2 diabetes, leading to their frequent presence in patients undergoing bariatric and other elective surgeries. These compounds significantly alter gastric motility, appetite, and nutrient intake, posing unique challenges for perioperative safety, surgical outcomes, and post-operative nutritional care. Understanding these implications is crucial to optimize patient management and prevent complications in a growing surgical population on GLP-1RAs.

This study conducted a narrative review synthesizing current evidence on GLP-1RA effects in surgical patients. Researchers systematically reviewed PubMed- and Scopus-indexed randomized trials, observational studies, systematic reviews, and clinical guidelines. The evidence was critically synthesized across several key domains: perioperative risk assessment, preoperative optimization strategies, post-bariatric surgery outcomes, and the broader nutritional implications for patients on these medications.

GLP-1RA use was consistently linked to delayed gastric emptying and increased residual gastric contents in some patients, particularly during dose escalation or in those experiencing gastrointestinal symptoms. However, the review found that clinically significant aspiration events were uncommon, suggesting that individualized perioperative management is more appropriate than routine discontinuation. Preoperatively, GLP-1RAs effectively promoted short-term weight loss and metabolic improvement in bariatric surgery candidates, potentially enhancing operative conditions and reducing surgical risks. Postoperatively, the strongest evidence from randomized controlled trials demonstrated that liraglutide and semaglutide achieved additional weight loss and improved glycemic control in patients experiencing weight regain, insufficient weight loss, or persistent diabetes after bariatric surgery. This could potentially reduce the need for revisional procedures. Nutritionally, the appetite-suppressing effects of GLP-1RAs may exacerbate inadequate protein intake and micronutrient deficiencies, increasing risks of sarcopenia, anemia, and bone disease without structured monitoring and supplementation.