A Statistical Framework for Person-centered Analysis of Digital Service Use in Public Health and Social Care.

Obesity affects more than 890 million adults globally []. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs)—including semaglutide (Ozempic/Wegovy) and liraglutide (Saxenda)—and the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 agonist tirzepatide (Mounjaro) represent the dominant modern pharmacological approach to obesity management, demonstrating sustained weight reductions of 15%–20% in pivotal trials [,]. With an increasing proportion of surgical patients taking these agents, a novel and systematically underappreciated patient safety hazard has emerged, which existing perioperative guidelines have not yet adequately addressed. Existing consensus statements have made important contributions to the management of perioperative GLP-1 RAs. However, they share some structural limitations that this review was designed to address. They have focused exclusively on GLP-1 RAs and aspiration risk, leaving orlistat, phentermine, topiramate, and bupropion/naltrexone unaddressed in the perioperative literature [–]. They do not address the misidentification trap—drug-induced adverse effects (pancreatitis, bowel obstruction, non-arteritic anterior ischemic optic neuropathy [NAION], and neuropsychiatric events) that are clinically and radiographically indistinguishable from surgical or anesthetic complications [,]. The consequences of misattribution are concrete: drug-induced pancreatitis blamed on the surgeon; bowel obstruction from premature resumption of a GLP-1 RA prompting unnecessary re-laparotomy; sudden visual loss from NAION attributed to anesthetic corneal injury; and emotional lability misinterpreted as emergence delirium. Each scenario causes clinical harm and medicolegal exposure to the clinician [–].