Evolving utilization of bariatric surgery since the rise of semaglutide and tirzepatide

Bariatric surgery volume in a large U.S. electronic health-record network rose until late 2022 and then fell 39%, while the share of surgery patients who had used a GLP-1 receptor agonist before surgery rose from 0.2% to 35.3%. Pre-surgery GLP-1RA use was more common in older, White, privately insured patients and varied widely by hospital.

Journal article — Retrospective cohort analysis of EHR data. Population: Patients who underwent primary sleeve gastrectomy or gastric bypass between 2018 and 2025 in Epic Cosmos. Follow-up: 2018 to 2025. Interventions: primary sleeve gastrectomy; gastric bypass; semaglutide; tirzepatide.

Bariatric surgery utilization increased after Q3 2018, peaked in Q4 2022, and fell 39% through Q4 2025. From Q4 2018 to Q4 2025, the proportion of Hispanic surgery patients increased from 8.1% to 16.8% and the proportion with pre-surgery GLP-1RA use increased from 0.2% to 35.3%. Type 2 diabetes was associated with pre-surgery GLP-1RA use (RR 2.94, 95% CI 2.88-3.00), while Hispanic ethnicity, Black race, and public or no insurance were associated with surgery upfront. After adjustment for patient characteristics and year, pre-surgery GLP-1RA use differed 15-fold between the highest and lowest hospitals (RR 0.19-2.88).

This paper quantifies how quickly semaglutide and tirzepatide use before bariatric surgery grew from 0.2% to 35.3% between 2018 and 2025 and shows that use is uneven across demographic and hospital factors. For researchers studying these drugs, it provides real-world context for interpreting bariatric surgery utilization as GLP-1 receptor agonist prescribing expands. It does not test whether semaglutide or tirzepatide improve surgical outcomes or replace surgery, and it offers no efficacy or safety data.

Key findings

• Bariatric surgery utilization peaked in Q4 2022 and then decreased 39% through Q4 2025.
• The proportion of Hispanic bariatric surgery patients increased from 8.1% in Q4 2018 to 16.8% in Q4 2025 (p < 0.001).
• The proportion of patients with pre-surgery GLP-1RA use increased from 0.2% in Q4 2018 to 35.3% in Q4 2025 (p < 0.001).
• Type 2 diabetes was associated with pre-surgery GLP-1RA use (RR 2.94, 95% CI 2.88-3.00).
• After adjustment, pre-surgery GLP-1RA use varied 15-fold across hospitals (RR 0.19-2.88).
• Hispanic ethnicity, Black race, and public or no insurance were associated with receiving surgery upfront.

Limitations

• Observational design cannot rule out residual confounding or establish causation.
• EHR dispensing records may not reflect whether patients actually took semaglutide or tirzepatide.
• Findings come from a single EHR system (Epic Cosmos) and may not generalize to all U.S. bariatric surgery patients.

The record

• Journal: Surgical endoscopy
• Published: 2026-07-17
• PMID: 42467193 — DOI: 10.1007/s00464-026-13147-z
• Funding: NIH Division of Loan Repayment
• Author countries: USA

Peptide profiles: Tirzepatide, Semaglutide.

All indexed evidence: Tirzepatide trials & papers, Semaglutide trials & papers.

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