Perioperative GLP-1 Receptor Agonist Use and 30-Day Outcomes After Breast Cancer Surgery: A Retrospective Cohort Study.

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for diabetes and obesity, but their perioperative safety in breast cancer surgery remains uncertain. This study evaluated the association between perioperative GLP-1 RA use and 30-day postoperative outcomes after breast cancer surgery. This retrospective cohort study included adults undergoing breast cancer surgery at a tertiary center (January 2024-August 2025). Exposure was active GLP-1 RA use within 30 days preoperatively, verified via pharmacy records. The primary outcome was a composite 30-day surgical morbidity endpoint (surgical site infection [SSI], flap necrosis ≥ grade II, seroma requiring aspiration, or implant/expander loss). Secondary outcomes included venous thromboembolism (VTE), readmission, reoperation, and length of stay. Multivariable regression and inverse probability of treatment weighting (IPTW) addressed confounding. The analytic cohort comprised 750 patients (209 exposed, 541 unexposed; median age 51 years). Exposed patients had higher body mass index and diabetes prevalence. After adjustment, GLP-1 RA exposure was not associated with SSI (adjusted odds ratio [AOR] 1.28, 95% CI 0.81-2.03), seroma (AOR 1.22, 95% CI 0.83-1.79), or flap necrosis ≥ grade II (AOR 1.41, 95% CI 0.83-2.40). No secondary outcome showed independent association with exposure. Prolonged length of stay (≥ 3 days) occurred in 26.8% of patients overall and was attributable primarily to drain management requirements, extent of surgery, and metabolic comorbidity rather than GLP-1 RA exposure. Perioperative GLP-1 RA use was not independently associated with increased short-term complications after breast cancer surgery. Multicenter studies are needed to confirm safety across settings.