Prior GLP-1RA or Tirzepatide Use and Early Cardiorenal Outcomes After Metabolic and Bariatric Surgery.

OBJECTIVE: To compare early postoperative cardiovascular and kidney outcomes after metabolic and bariatric surgery (MBS) according to prior glucagon-like peptide-1 receptor agonist (GLP-1RA) or tirzepatide use. METHODS: This retrospective cohort study used the US Medical Records Database. Adults undergoing MBS from 2016 through 2025 were included. Prior use was defined by at least 1 GLP-1RA or tirzepatide prescription from 365 to 7 days before MBS; patients with prescriptions closer to surgery were excluded. Prior users and nonusers were propensity score matched 1:1. The primary outcome was 4-point major adverse cardiovascular events (MACE), and a key secondary outcome was early postoperative kidney events, assessed from postoperative day 1 through day 90. RESULTS: After matching, each group included 11,052 patients, with well-balanced baseline characteristics. Prior use was associated with lower risks of 4-point MACE (36 patients [0.3%] vs 67 patients [0.6%]; hazard ratio [HR], 0.535; 95% CI, 0.357-0.803) and early postoperative kidney events (158 patients [1.4%] vs 256 patients [2.3%]; HR, 0.613; 95% CI, 0.502-0.747). Prior GLP-1RA or tirzepatide use was also associated with lower risks of coronary events and heart failure. CONCLUSIONS: Among adults undergoing MBS, prior GLP-1RA or tirzepatide use was associated with lower 90-day risks of 4-point MACE and early postoperative kidney events. These findings support further investigation of preoperative metabolic optimization strategies and their potential role in improving postoperative cardiorenal outcomes.