Today, approximately 1 in every 8 US adults take glucagon-like peptide-1 receptor agonist (GLP-1RA) drugs, and half of all Americans may benefit from doing so
Many surgeons now encounter these patients in daily practice, even if their surgical specialty is not directly related to obesity
This reality leads to important questions: How can GLP-1RA drugs help patients prepare for safer, more effective surgery? What information will surgeons need to optimize outcomes for patients taking these drugs?
An Ongoing Conversation
Although GLP-1RA drugs are highly popular and frequently prescribed, their use has been widespread for only a few years. In that time, a wide range of benefits has emerged, ranging from the expected weight loss and glycemic control to improvements in cardiovascular and kidney health, reductions in inflammation and related autoimmune disease, positive shifts in mood and anxiety disorders, and even remission of addiction symptoms. This panoply has helped drive the drugs’ popularity
“In many ways, this is the golden era for the treatment of chronic disease,” said Thomas C. Tsai, MD, MPH, FACS, a bariatric surgeon and Medical Director for Health Policy Research in the ACS Division of Advocacy and Health Policy, at an ACS press conference in October 2025, urging wider access to and use of GLP-1RA drugs in patients with obesity
However, perhaps by the very fact of their wide-ranging outcomes, much about GLP-1RAs remains unknown. Scientific literature on GLP-1RA drugs is rapidly accumulating, but the duration of use is insufficient to clarify the full scope of these benefits, as well as any drawbacks the drugs may pose
Consequently, the ongoing conversation on how surgeons can best help GLP-1RA users prepare for surgery remains a priority
“It’s important for us as physicians, and surgeons in particular, to be aware of the prevalence of their use, as well as the potential implications in terms of perioperative management, risk mitigation, and preparation for surgery,” added Vivek N. Prachand, MD, FACS, a professor of surgery at The University of Chicago in Illinois
Preventing Gastric Content Aspiration
Ann M. Rogers, MD, FACS, the immediate past president of the American Society for Metabolic and Bariatric Surgery (ASMBS) and a professor emerita of bariatric surgery at Penn State Health in Hershey, Pennsylvania, explained the most frequent scenario in which surgeons encounter patients taking GLP-1RA drugs
“It’s very common now for patients to be on them prior to surgery, not necessarily because it was started as a specific way to make the surgery safer, but just because they were already on it,” said Dr. Rogers
As a result, a top concern for many surgeons, including those who are not involved in bariatric surgery, is avoiding a specific risk that may be intensified by GLP-1RA usage: gastric content aspiration
It is rare that anesthetized patients aspirate gastric contents, and even rarer that such aspiration causes pneumonia. Nonetheless, the complication is serious enough to warrant fasting prior to most surgeries. The challenge with GLP-1RA drugs is that they depress appetite in part by slowing gastric emptying, and therefore standard fasting times may not eliminate gastric contents
In response to these concerns, surgical societies have updated protocols aimed at mitigating the risk of aspiration. In 2023, the American Society of Anesthesiologists advised holding all GLP-1RA drugs for a day (if taken daily) or a week (if taken weekly) before surgery. In contrast, 2024 guidance from the American Gastroenterological Association suggested most patients using GLP-1RA drugs could continue them safely before surgery.1
More recently, multisociety guidance endorsed by both organizations has advised that most patients can continue GLP-1RAs before surgery.2 Data now suggest that suspending intake may sacrifice glycemic control and fail to eliminate residual gastric contents,3 but those using GLP-1RA drugs continuously do not experience elevated aspiration pneumonia risk.3
Thomas K. Varghese Jr., MD, MS, MBA, FACS, chief of general thoracic surgery at the University of Utah in Salt Lake City, offered a more cautious perspective: “It’s still too early right now, I think, for us to really know what the true incidence rate is around adverse events with GLP-1 receptor agonists.”
But per current guidelines, it appears limiting GLP-1RA intake before surgery could be unnecessary, easing concerns about balancing efficient surgery with patient safety
Lowering Body Mass
Beyond preventing complications, many surgeons are embracing the opportunity to improve patient outcomes with GLP-1RA drugs. Because obesity plays a role in the outcomes of many surgical procedures, the most intuitive focus for many surgeons is lowering body mass index (BMI) with preoperative GLP-1RA use
“We do a lot of abdominal wall reconstruction and foregut and esophageal procedures, many of which benefit from having patients be at a lower BMI range so that the long-term outcomes of the procedures are better in terms of reduced risk of recurrence, reduced reflux, and so forth. There are similar strategies used, for example at our institution, with transplant patients and orthopaedic patients who need to lose weight,” said Dr. Prachand, whose practice focuses on minimally invasive surgery.
The ASMBS and other organizations offer no official guidance on which patients should engage in GLP-1RA therapy before bariatric or other types of surgery, and some research has found, rather counterintuitively, that BMI and postoperative risk are not clearly associated.4
However, prescribing GLP-1RAs to lower BMI before surgery aligns with emerging evidence that this approach can help patients reduce weight and lower postsurgical risks.5 For example, a 2025 study of 70 patients undergoing elective hernia repair after GLP-1RA usage found a 30-day morbidity rate of 9.1%,5 a rate lower than typical
Research results are more definitive for those patients with unusually high or low BMIs. For example, a study presented at the 2025 annual meeting of the ASMBS using ACS Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data found the overall occurrence of mortality and morbidity rose from 2.77% in those with BMIs of 30 to 34.9, to 3.99% in those with BMIs greater than 70, with a marked increase in all BMI levels greater than 50.6
