BACKGROUND: Semaglutide is a medication for weight loss in obese patients. Recently, many plastic surgeons have recommended semaglutide following bariatric surgery to increase weight loss. However, postoperative complications such as wound dehiscence, delayed healing, and infection pose significant risks. OBJECTIVES: In this study we aimed to examine the relationship between preoperative semaglutide and postoperative complications in nondiabetic obese patients undergoing body contouring surgery. We hypothesized that semaglutide would increase the risk of postoperative complications. METHODS: In this retrospective cohort study we utilized the TriNetX Research database. Nondiabetic patients who underwent body contouring surgery between 2021 and 2024 after bariatric procedures were included. Patients were divided into 2 cohorts: Cohort A (4215 patients), which received semaglutide for ≥6 months before surgery, and Cohort B (104,927 patients), without semaglutide. Propensity score matching was employed to create comparable cohorts based on age, gender, race, and BMI. The primary outcomes included postoperative complications within 30 days of surgery. RESULTS: Significant differences were found between the cohorts. Semaglutide patients had higher rates of wound dehiscence (5.19% vs 2.78%, P <
.0001)
delayed wound healing (2.58% vs 1.21%, P <
.0001)
surgical site infections (5.37% vs 2.87%, P <
.0001)
nausea, vomiting, and diarrhea (11.27% vs 5.34%, P <
.0001)
hypertrophic scar formation (5.53% vs 3.86%, P = .0011)
and surgical site pain (6.05% vs 3.29%, P <
.0001). CONCLUSIONS: Preoperative semaglutide in nondiabetic patients undergoing body contouring surgery following bariatric procedures is associated with higher rates of adverse postoperative outcomes. These findings highlight the need for enhanced preoperative counseling and surgical planning to minimize risks and improve patient outcomes.