"GLP-1 Agonists vs. Bariatric Surgery: A Global Health Network Analysis of Panniculectomy Outcomes".

Abstract

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. To compare panniculectomy outcomes and perioperative lab values in patients with prior GLP-1 use versus bariatric surgery. 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 perioperative laboratory values were compared between groups, including hemoglobin A1c (HgA1c), body mass index (BMI), low-density lipoprotein (LDL), triglycerides, and albumin. Propensity score matching for age, sex, race, HbA1c, BMI, and triglyceride levels was performed to stabilize baseline metabolic profiles and allow balanced comparison of postoperative outcomes, including cellulitis, hematoma, seroma, hemorrhage, wound dehiscence, surgical site infection, and abscess formation. Data from 177,467,699 patients across 150 healthcare organizations (2020-2025) were analyzed. Among all patients who underwent panniculectomy (n=24,645), 6,060 had preoperative GLP-1 use and 4,142 had prior bariatric surgery. GLP-1 users exhibited higher perioperative triglycerides, HbA1c, BMI, and LDL (all p < 0.05). Multivariable regression demonstrated lower odds of cellulitis (OR 0.62, 95% CI 0.47-0.83, p=0.0015), seroma (OR 0.77, 95% CI 0.59-0.89, p=0.026), and hemorrhage (OR 0.51, 95% CI 0.30-0.89, p=0.016) in the GLP-1 cohort. Despite initial concerns, preoperative patients who achieve weight loss via GLP-1 receptor agonists, as opposed to bariatric surgery, may experience fewer postoperative complications following panniculectomy.