TOPLINE: 

Among patients with obesity and type 2 diabetes (T2D) who underwent general surgery, prior metabolic bariatric surgery (MBS) was associated with lower odds of postoperative complications compared with prior GLP-1 therapy.

METHODOLOGY: 

• Obesity and T2D increase the risk of post-operative complications in general surgery, but weight-loss approaches such as MBS and GLP-1 therapy may improve metabolic health and reduce complication risk in subsequent general surgery.
• To compare the effectiveness of the two approaches, researchers analyzed electronic health record data for 9470 patients (median age, 64 years; 60.6% women) with obesity (BMI ≥ 30) and T2D who underwent non-MBS general surgery and had undergone MBS (1647 patients) or received GLP-1 therapy (7823 patients) 1-3 years before the operation.
• GLP-1 use was defined as maintaining a continuous prescription for at least 1 year before general surgery, with medication coverage of at least 80% of days in that period. Eligible MBS procedures were sleeve gastrectomy, Roux-en-Y gastric bypass, and adjustable gastric banding.
• The median time from the weight-loss intervention to general surgery was 653 days.
• The primary outcomes were change in BMI after the weight loss intervention, BMI at the time of general surgery, and postoperative surgical complications. Secondary outcomes included readmission and extended hospital length of stay, defined as a stay greater than the 75^th percentile.

TAKEAWAY: 

• Patients who underwent MBS were more likely to have a baseline BMI ≥ 40 than GLP-1 users (60.8% vs 24.5%). MBS was independently associated with a greater reduction in BMI compared with GLP-1 therapy (mean difference, -9.89; P < .001 for both).
• Each one-unit increase in BMI at the time of general surgery was independently associated with slightly higher odds of postoperative complications at 30 days (odds ratio [OR], 1.01; P = .018) and extended length of stay (OR, 1.01; P = .014).
• Compared with GLP-1 therapy, prior MBS was independently associated with lower odds of postoperative complications (OR, 0.87; P = .025), readmission (OR, 0.81; P = .01), and a lower risk for extended length of stay (OR, 0.57; P = .001) after subsequent general surgery.
• Among patients with a baseline BMI ≥ 35, a greater reduction in BMI following obesity treatment correlated with lower odds of postoperative complications after general surgery. There was no such correlation in patients with baseline BMI 30-34.

IN PRACTICE:

"Preoperative weight loss is an important modifiable risk factor among patients with obesity and T2D who have plans to undergo a non-MBS general surgical procedure. … Implementing structured weight loss programs before elective surgery can substantially mitigate surgical morbidity among high-risk obese populations," the authors wrote.

SOURCE: 

The study, led by Shahzaib Zindani, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, was published online in Clinical Obesity.

LIMITATIONS: 

The analysis may have been affected by coding errors, inaccurate data entry, and incomplete records. Data on surgical complexity, intraoperative variables, patient physical status, provider- and institution-level factors, lifestyle recommendations, and detailed social determinants of health were unavailable. Postoperative complications were identified solely using diagnostic codes without conducting standardized severity grading.

DISCLOSURES:

The authors reported having no relevant conflicts of interest or funding source.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.