What is the evidence for using preoperative Glucagon-like peptide-1 (GLP-1) agonists, such as liraglutide (generic name), to reduce postoperative complications in patients with a Body Mass Index (BMI) of 40 undergoing general surgery?

From the Guidelines

The use of preoperative GLP-1 agonists, such as liraglutide, in patients with a BMI of 40 undergoing general surgery is not supported by sufficient evidence to recommend routine use for reducing postoperative complications. While GLP-1 agonists have benefits for weight loss and glycemic control, their role in the preoperative setting remains investigational. According to a recent narrative review 1, there is insufficient evidence to provide definitive guidance on the ideal cessation period for GLP-1 receptor agonists before elective surgery, suggesting a precautionary approach is required until more evidence becomes available.

For patients taking GLP-1 receptor agonists for weight management, it is suggested that these drugs should be withheld for at least three half-lives before an elective surgical procedure 1. The typical dosing of liraglutide for weight management is 3.0 mg subcutaneously once daily, usually initiated at 0.6 mg daily and titrated upward weekly by 0.6 mg to minimize gastrointestinal side effects. If considering preoperative use, treatment should ideally begin several weeks before surgery to achieve meaningful weight reduction and metabolic improvement.

Key considerations include:

• Monitoring for common side effects such as nausea, vomiting, and diarrhea, which could potentially interfere with preoperative nutritional status if severe
• Theoretical benefits of reduced technical difficulties during surgery, improved wound healing, and decreased risk of cardiopulmonary and thromboembolic complications through preoperative weight loss and improved glycemic control
• Individualized, evidence-based approach, particularly for patients with type 2 diabetes mellitus, where discussion with an endocrinologist is advised to balance the risks and benefits of GLP-1 agonist cessation before surgery 1.

From the Research

Evidence for Preoperative GLP-1 Agonist Use in Patients with BMI 40

• The use of GLP-1 agonists, such as liraglutide, has been studied in the context of preoperative weight loss for patients with severe obesity undergoing bariatric-metabolic surgery 2.
• A study published in 2023 found that treatment with GLP-1 receptor agonists, including liraglutide, resulted in significant weight loss in patients on a waiting list for bariatric surgery, with 68.6% of participants satisfied with their weight loss and withdrawing from the waiting list 3.
• Another study from 2023 investigated the use of GLP-1 agonists in high-risk patients prior to bariatric surgery and found that GLP-1 agonist use was associated with a 5.5-point reduction in BMI, without increased time to surgery or complication rate 4.
• A 2025 study examined the use of GLP-1 receptor agonists as a prehabilitation tool for weight loss in obese patients undergoing elective hernia repair and found that GLP-1 agonists accelerated preoperative weight loss without negatively impacting postoperative outcomes 5.
• A 2025 study published in The Journal of Bone and Joint Surgery found that the perioperative use of GLP-1 receptor agonists in patients with a BMI of ≥40 kg/m² undergoing primary total knee arthroplasty decreased medical and surgical complications, including periprosthetic joint infection and readmission 6.

Key Findings

• GLP-1 agonists can be an effective adjuvant therapy for preoperative weight loss in patients with severe obesity 2.
• Treatment with GLP-1 receptor agonists can result in significant weight loss and improved patient satisfaction 3.
• GLP-1 agonist use may reduce perioperative complications in high-risk patients undergoing bariatric surgery 4 and in obese patients undergoing elective hernia repair 5.
• The use of GLP-1 receptor agonists may decrease medical and surgical complications in morbidly obese patients undergoing primary total knee arthroplasty 6.