Preoperative optimization with tirzepatide in obese patients: impact on surgical complications and postoperative recovery

Abstract

Obesity is an important risk factor for perioperative complications and is associated with increased surgical morbidity and mortality, ventilatory difficulties, cardiovascular events, metabolic alterations, and prolonged postoperative recovery. In this context, preoperative optimization strategies aimed at reducing clinical risk have received increasing attention, particularly tirzepatide, a dual agonist of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. This study aimed to critically analyze the scientific evidence regarding the use of tirzepatide for preoperative optimization in obese patients undergoing surgical procedures, with emphasis on its impact on perioperative complications, metabolic parameters, and surgical recovery. This study consisted of an integrative literature review based on the methodological framework proposed by Whittemore and Knafl, conducted using the PubMed/MEDLINE, Scopus, and SciELO databases. The findings demonstrated that tirzepatide promotes substantial and sustained weight loss, in addition to significant improvements in metabolic parameters associated with surgical risk, including glycemic control, insulin resistance, and cardiometabolic profile. Furthermore, a potential benefit was observed in reducing clinical factors associated with perioperative morbidity. However, controversies remain regarding the anesthetic management of these patients, particularly due to delayed gastric emptying and the potential risk of pulmonary aspiration. It is concluded that tirzepatide represents a promising strategy for the preoperative optimization of obese patients, although additional prospective studies are needed to clarify its impact on specific surgical outcomes and to establish more clearly defined perioperative protocols.