Disparities in Access to GLP-1 Receptor Agonists at the Surgical Interface: A Scoping Review

This scoping review maps the evidence on disparities in access to glucagon-like peptide-1 receptor agonists (GLP-1RAs) across the access cascade, with surgical care as a co-primary focus. GLP-1RAs have rapidly changed obesity management, including the clinical pathways that lead to and follow surgery: metabolic and bariatric procedures, general surgery, and plastic and body-contouring surgery after weight loss. Access to these drugs, however, varies with insurance coverage, cost, socioeconomic position, race and ethnicity, geography, and prescribing practice. Studies of these disparities are scattered across medical, health-services, and policy literatures. No synthesis has mapped where along the cascade they have been measured, or how much of this evidence concerns surgical patients, the group in whom GLP-1RA access increasingly shapes candidacy, timing, and outcomes of surgery. The review is conducted using JBI scoping review methodology and reported according to PRISMA-ScR. We search PubMed/MEDLINE, Scopus, and Web of Science, and include studies of GLP-1RAs or anti-obesity medication classes that include them. Two reviewers independently screen and chart included studies. For each study, we chart disparities across five cascade stages (eligibility, prescribing or initiation, fill or utilization, persistence, and cost or coverage policy) and five disparity axes (insurance or coverage, socioeconomic status or area deprivation, race and ethnicity, geography or rurality, and sex, language, and other equity variables). Studies with a surgical population, outcome, subgroup, or coverage analysis are charted in more detail, including surgery type and the timing of GLP-1RA use relative to surgery. Expected outputs are an evidence map of disparity axes by cascade stage, shown separately for surgical contexts and for all studies; a narrative synthesis of the surgical evidence and of each cascade stage; an appraisal of study quality; and an explicit account of the evidence gaps. The aim is to give surgeons, health-system leaders, and policymakers a clear picture of what is known about inequitable GLP-1RA access around surgical care, and to set priorities for future research.