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GLP-1 Agonists vs. Bariatric Surgery: A Global Health Network Analysis of Panniculectomy Outcomes
Peyton H. Terry, MD, Savannah Braud, BS, Joseph M. Serletti, MD, Saïd Azoury, MD.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: With the rise in medically assisted weight loss, procedures like panniculectomy are increasingly common. The surgical impact of glucagon-like peptide-1 (GLP-1) receptor agonists remains unclear, particularly compared to bariatric surgery. This study aims to compare panniculectomy outcomes and perioperative lab values in patients with prior GLP-1 use versus bariatric surgery.
METHODS: TriNetX Global Research Network was queried to identify patients who underwent panniculectomy following either GLP-1 use or bariatric surgery. Cohorts were formed using codes such as CPT and ICD-10 and matched by age, sex, and race. Postoperative complications assessed were cellulitis, hematoma, seroma, hemorrhage, wound dehiscence, surgical site, and abscess formation. Perioperative laboratory values analyzed included hemoglobin A1c, body mass index (BMI), low-density lipoprotein LDL, triglycerides, and albumin.
RESULTS: A total of 177,467,699 patients from 150 healthcare organizations were analyzed from 2005-2025. Among patients who underwent panniculectomy (n=8,488), 4,821 (56.8%) had preoperative GLP-1 use, and 3,667 (43.2%) had prior bariatric surgery. GLP-1 users exhibited higher perioperative triglycerides, HbA1c, and BMI (all p < 0.0001). Multivariable regression revealed GLP-1 users had lower odds of cellulitis (OR 0.590, 95% CI 0.437-0.797, p=0.0005), seroma (OR 0.739, 95% CI 0.557-0.980, p=0.0353), and hemorrhage (OR 0.481, 95% CI 0.269-0.860, p=0.0117). Additionally, GLP-1 users had significantly higher perioperative albumin levels (p < 0.0001).
CONCLUSION: Despite initial concern, GLP-1 agonists are associated with fewer postoperative complications after panniculectomy when compared to bariatric surgery. This may be due in part to improved perioperative nutrition status, though other confounding factors may also contribute to these findings.
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