Title: ASSOCIATION OF GLP-1 AGONIST USE WITH SLEEVE GASTRECTOMY OUTCOMES: A RETROSPECTIVE COHORT STUDY

Authors: Simranjeet K. Sidhu*, Hee-Jung J. Kim*, Katharine P. Playter, Zachary Ballinger, Hayley Reddington, Richard Perugini
*These authors contributed equally.

Department of Surgery, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA

Introduction 

Obesity is a major health concern linked to numerous comorbid conditions impacting quality of life and increased mortality. While bariatric surgery is widely accepted as an effective intervention, not all patients experience optimal outcomes. With the growing use of glucagon-like peptide-1 receptor agonists (GLP-1RA), we examined the relationship between timing and duration of GLP-1 agonist use and outcomes following sleeve gastrectomy (SG). 

 

Methods and Procedures

We conducted a retrospective cohort study of 1380 patients who underwent SG at a metropolitan tertiary care center between January 2020 and December 2023. GLP-1 agonist usage within 1 year of surgery was required for inclusion in the GLP-1 group. Subgroup analysis was performed by timing of use (preoperative, postoperative, or both) and stratified into quartiles by duration of use. Demographic variables including age, race, insurance status, and preoperative comorbidities were obtained. Outcomes of interest included percent excess body weight loss (%EBWL), percent total weight loss at 1 year and 2 years, and hemoglobin A1C (HbA1c) change at 1 year postoperatively. Statistical analysis was performed using two-sample t-test, ANOVA, and Chi-square test of independence. 

 

Results 

Among 1380 patients, 178 (12.95%) used GLP-1RA within 1 year of SG. GLP-1RA was more likely to be used by individuals who were older, male, and had pre-existing type 2 diabetes mellitus.  

Patients not receiving GLP-1RA achieved significantly greater percent weight loss at 1 and 2 years postoperatively than patients that used GLP-1RA. Preoperative GLP-1RA use was associated with a greater %EBWL (60.22%; SD = 24.68) at 1 year postoperatively than postoperative use alone (49.86%; SD = 17.48) and use during both periods (46.13%; SD = 22.68) (p < 0.001). Longer GLP-1RA use was also associated with decreased %EBWL and percent weight loss 1 year postoperatively. GLP-1RA usage did not lead to a difference in HbA1c change one year after SG.

 

Conclusions 

In this cohort, GLP-1 agonists use in patients undergoing SG was associated with older age, male gender, and pre-existing diabetic patients. GLP-1 agonist use was associated with reduced weight loss following SG. One reason for these findings may be that GLP-1 agonists are used conservatively in this practice, to aid individuals experiencing suboptimal outcomes. These findings highlight the need for future studies to optimize GLP-1 agonist administration.