Abstract Body (Do not enter title and authors here): Background:

GLP-1 receptor agonists have demonstrated cardiovascular and metabolic benefits in patients with obesity and type 2 diabetes. However, their impact on clinical outcomes following bariatric surgery remains unclear.

Objective:

To evaluate the association between post-operative GLP-1 analog use and key clinical outcomes among patients who underwent bariatric surgery.

Methods:

We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Adults (BMI ≥30) who underwent bariatric surgery were divided into two cohorts: those who initiated GLP-1 analogs post-operatively and those who did not. After 1:1 propensity score matching, 18,017 patients were included in each group. The primary outcome was all-cause mortality; secondary outcomes included major adverse cardiovascular events (MACE), atrial fibrillation/flutter, hospital readmission, HbA1c <7% achievement, acute pancreatitis, and gastroparesis. Outcomes were assessed over a 12-month follow-up.

Results:

All-cause mortality was comparable between groups (0.3% vs. 0.3%; HR 0.777, p=0.084). GLP-1 users experienced a slightly higher incidence of MACE (1.7% vs. 1.3%; HR 1.27, p=0.006) and atrial fibrillation/flutter (3.2% vs. 3.1%; HR 1.02, p=0.179), though only the MACE difference reached statistical significance. Notably, GLP-1 use was associated with reduced readmissions (20.1% vs. 25.5%; HR 0.74, p<0.001) and higher rates of glycemic control (HbA1c <7%: 35.1% vs. 32.3%; HR 1.07, p=0.001). There was no significant difference in acute pancreatitis. Gastroparesis was less frequent in GLP-1 users (0.6% vs. 0.8%; HR 0.76, p=0.028).

Conclusion:

In this large real-world cohort, post-operative GLP-1 analog use was associated with improved glycemic control and reduced readmissions, without an increase in all-cause mortality or pancreatitis. Slightly higher rates of MACE warrant further investigation. These findings support the selective use of GLP-1 analogs as adjuncts following bariatric surgery.