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Background <p>A 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.</p> Methods <p>This 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.</p> Results <p>In the propensity score–matched cohorts (<i>n</i> = 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, <i>p</i> &lt; 0.001). Suboptimal weight control was more prevalent in the exposure group (HR:1.18, <i>p</i> = 0.014), while suboptimal glycemic control, hospitalization, and ED visits showed no significant differences. Similar patterns were observed across surgical subtypes and age groups.</p> Conclusion <p>Preoperative 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.</p>

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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

  • 期刊论文

  • 发表日期：

    2026年4月11日

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  • Kuo-Chuan Hung,
  • Shu-Wei Liao,
  • Ting-Sian Yu,
  • Wei-Cheng Liu,
  • Ying-Jen Chang,
  • I-Wen Chen

摘要

Background

A 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.

Methods

This 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.

Results

In 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.

Conclusion

Preoperative 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.