Adults taking GLP-1 receptor agonists before elective surgery experienced a lower rate of major cardiovascular events and postoperative infections, according to an analysis of more than two million patient records presented at the ANESTHESIOLOGY 2026 annual meeting.
GLP-1 medications have become part of everyday care for many people with diabetes or obesity, but physicians still need more evidence about how these drugs affect patients around the time of surgery,
said Josephine Tolan, lead study author, as cited by Newswise.
The study examined electronic health records from the Epic Cosmos database, which aggregates information from more than 1,700 hospitals and 40,000 clinics. Researchers analyzed data from 2,028,601 adults who underwent elective surgeries lasting longer than 60 minutes and required at least 24 hours of hospitalization between January 2016 and December 2024. Among those patients, 145,610 were receiving GLP-1 therapy.
Cardiovascular and Infection Outcomes in Matched Patient Groups
To establish comparable cohorts, investigators used statistical matching techniques, resulting in an analysis group that accounted for demographic characteristics, medical conditions, and prior medication use. Major adverse cardiovascular events—defined as heart attack, myocardial injury, stroke, and death from any cause—occurred in 1 percent of GLP-1 users compared with 1.1 percent of non-users. This represented an 11 percent reduction in the odds of major cardiovascular complications.
Postoperative infections followed a similar pattern. Surgical site infections, urinary tract infections, pneumonia, and sepsis affected 4.9 percent of GLP-1 users and 5.3 percent of non-users, yielding an 8 percent reduction in the odds of postoperative infections. While the absolute differences between the groups were small, researchers noted that across millions of annual procedures, the findings carry potential clinical relevance.
Secondary outcomes evaluated in the data showed no significant differences between groups for acute kidney injury, myocardial infarction, transient ischemic attack, cerebral infarction, and arrhythmia. Additional secondary endpoints tracked GLP-1-related complications including acute pancreatitis, gastroparesis, and abnormal weight loss.
Biological Plausibility and Unresolved Fasting Safety Concerns
Specialists point out that the results align with the known metabolic profile of GLP-1 receptor agonists, which include semaglutide and tirzepatide-based treatments originally developed for type 2 diabetes. Improved blood sugar regulation helps support immune function and wound healing, while anti-inflammatory properties may protect heart muscle under surgical stress.
Beyond their effects on appetite and satiety, these drugs may also modulate inflammatory pathways, which could help explain the associations we observed.
However, the findings intersect with an ongoing debate regarding preoperative management. Because GLP-1 medications delay gastric emptying, physicians remain concerned that residual stomach contents may persist despite standard fasting protocols, increasing the risk of pulmonary aspiration during anesthesia. In related safety guidance, the Australian and New Zealand College of Anaesthetists emphasized that patients taking these peptides or weight-loss injections must alert their surgical teams to allow individualized fasting assessments.
Observational Limits and Guidance for Surgical Patients
Because the research relied on retrospective electronic health records rather than randomized trials, investigators cautioned that the study cannot prove direct cause and effect. Unmeasured differences between patients may have contributed to the lower complication rates, and the analysis did not track exact medication cessation timelines prior to procedures.