# Safety of GLP-1 receptor agonists in body contouring surgery- a systematic review > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/safety-of-glp-1-receptor-agonists-in-body-contouring-surgery-a-systematic-revie/ > **Published:** 2026-06-03T18:36:31-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T10:53:28-04:00 > **Clinical Summary:** Explore the safety of GLP-1 RAs in body contouring surgery, including wound dehiscence risk and other complications. --- ## GLP-1 Agonists in Body Contouring Surgery: What the Evidence Shows GLP-1 Receptor Agonists Body Contouring Surgery Wound Healing Semaglutide Perioperative Safety **What You’ll Learn:** - How perioperative GLP-1 RA use compares to no exposure across wound-healing outcomes in 8,944 body contouring patients - Why the pooled wound dehiscence signal deserves careful scrutiny before clinical translation - Which complications showed no statistically significant difference between GLP-1 RA users and non-users - What the current evidence does — and does not — support for perioperative management decisions **TL;DR:** A [systematic review](https://cedclinic.com/cannabinoid-safety-efficacy-mental-health-study/) and meta-analysis of 8,944 patients found a statistically significant association between perioperative GLP-1 RA use and wound dehiscence (RR 1.62; 95% CI 1.09–2.42), but that signal disappears in leave-one-out sensitivity analysis when a single large cohort is removed, and no other surgical site outcomes reached significance. STUDY TYPE: [Systematic Review](https://cedclinic.com/cannabinoid-safety-efficacy-mental-health-study/) and Meta-Analysis ## Abstract **Background:** The rapid adoption of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for [weight management](https://cedclinic.com/cannabis-metabolism-weight-management-science/) has created new considerations for plastic surgeons, particularly regarding their impact on wound healing and perioperative outcomes. Patients presenting for body contouring procedures increasingly use GLP-1 RAs, yet the safety of these agents in surgical populations remains unclear. **Methods:** The authors conducted the first systematic review and meta-analysis in accordance with Cochrane’s Handbook and PRISMA reporting guidelines comparing adults undergoing body-contouring procedures with and without GLP-1 RA exposure. Primary outcomes were surgical site occurrences (SSOs), including wound dehiscence, surgical site infection (SSI), seroma, and hematoma. Secondary outcomes included readmission, emergency visits, and gastrointestinal complications. Risk of bias was assessed using ROBINS-I, and pooled risk ratios (RRs) were calculated with random-effects models. Sensitivity was evaluated with leave-one-out (LOO) analyses. **Results:** From 1,479 screened records, four studies (three retrospective, one prospective) comprising 8,944 patients were included. Semaglutide was the most frequently reported agent, accounting for more than 99% of prescriptions. Meta-analysis demonstrated a significantly higher risk of wound dehiscence among GLP-1 RA users (5.2% vs. 2.9%; RR 1.62; 95% CI 1.09–2.42; p=0.017; I²=0%). No significant differences were observed for seroma (RR 0.78; 95% CI 0.30–2.05; p=0.613; I²=62.7%), hematoma (RR 1.74; 95% CI 0.72–4.24; p=0.220; I²=0%), or SSI (RR 1.16; 95% CI 0.48–2.77; p=0.746; I²=65.6%). Composite SSO analysis also showed no significant difference (RR 1.31; 95% CI 0.90–1.90; p=0.164; I²=80.7%). Leave-one-out sensitivity analysis attenuated the wound dehiscence association to non-significance (RR 1.02; 95% CI 0.46–2.26) when the largest cohort was removed. ROBINS-I assessment rated all studies at moderate or serious risk of bias. **Conclusions:** GLP-1 RA use in body contouring surgery may be associated with an increased risk of wound dehiscence, although this finding appears largely driven by a single large cohort study. Other perioperative complications were not consistently elevated, but substantial heterogeneity and limited evidence reduce certainty. Further prospective studies are needed to guide perioperative management in this expanding patient population. **Source:** Collaco BG, Gomez-Cabello CA, Haider SA, et al. Safety of GLP-1 receptor agonists in body contouring surgery: a systematic review and meta-analysis. *BMC Plastic and Reconstructive Surgery.* 2026;2:13. **DOI:** [https://doi.org/10.1186/s44452-026-00024-w](https://doi.org/10.1186/s44452-026-00024-w) ## Study at a Glance Design Systematic review and meta-analysis (3 retrospective cohorts, 1 prospective comparative study) Population Adults undergoing body contouring procedures (abdominoplasty, panniculectomy, brachioplasty, thighplasty, lipoabdominoplasty, mastopexy, and others) Total N 8,944 patients across 4 studies Primary Endpoint Surgical site occurrences (SSOs): wound dehiscence, SSI, seroma, hematoma Key Finding Wound dehiscence was significantly higher in GLP-1 RA users on pooled analysis (RR 1.62), but this association was not robust in sensitivity analysis; no other SSO was significantly elevated ## Study Snapshot Outcome GLP-1 RA Rate Control Rate Pooled RR (95% CI) p-value I² Wound Dehiscence 5.2% 2.9% 1.62 (1.09–2.42) 0.017 0% Seroma 9.2% 12.3% 0.78 (0.30–2.05) 0.613 62.7% Hematoma 4.6% 2.6% 1.74 (0.72–4.24) 0.220 0% Surgical Site Infection 5.3% 3.3% 1.16 (0.48–2.77) 0.746 65.6% Composite SSO 13.9% 9.2% 1.31 (0.90–1.90) 0.164 80.7% LOO sensitivity: wound dehiscence RR 1.02 (0.46–2.26) after removing Lewis et al. 2025 ## Study Facts Table Authors Collaco BG, Gomez-Cabello CA, Haider SA, Genovese A, Prabha S, Rinker BD, Forte AJ, Elegbede AI Journal BMC Plastic and Reconstructive Surgery Year 2026 Study Design Systematic review and meta-analysis; 3 retrospective cohorts, 1 prospective comparative study with historical controls Total N 8,944 patients (4 studies); largest single cohort: Lewis et al. 2025, n=8,314 Intervention Perioperative GLP-1 RA exposure (semaglutide >99% of prescriptions across studies) Comparator No GLP-1 RA exposure Primary Endpoint SSOs: wound dehiscence, SSI, seroma, hematoma Key Results Wound dehiscence: RR 1.62 (1.09–2.42), p=0.017, I²=0%; attenuated to RR 1.02 (0.46–2.26) on LOO analysis removing Lewis et al. All other outcomes non-significant. Composite SSO RR 1.31 (0.90–1.90), p=0.164, I²=80.7% [Adverse Events](https://cedclinic.com/cbd-endocrine-effects-gynecomastia-risk-safety/) Lewis et al. reported nausea, vomiting, diarrhea, hypertrophic scars, and surgical site pain at higher rates in GLP-1 RA users; not systematically pooled across all studies Funding No external funding reported Conflict of Interest Authors declare no competing interests ROBINS-I Assessment All studies rated moderate or serious risk of bias; Albanese 2025 rated serious overall ## What Researchers Actually Did Collaco and colleagues at the Division of Plastic Surgery, Mayo Clinic Jacksonville, searched PubMed, Embase, and the Cochrane Library through August 10, 2025, for studies comparing adults undergoing body contouring procedures with and without GLP-1 RA exposure. From 1,479 screened records, four studies met inclusion criteria: three retrospective cohorts and one prospective comparative study with historical controls. The combined population comprised 8,944 patients, the overwhelming majority of whom were female and predominantly in the obese BMI range. Semaglutide accounted for more than 99% of all GLP-1 RA prescriptions across included studies, driven largely by the Lewis et al. 2025 cohort, which enrolled 4,157 matched non-diabetic post-bariatric patients exclusively treated with semaglutide. Binary outcomes were synthesized using Mantel-Haenszel random-effects models, with between-study heterogeneity further characterized via restricted maximum likelihood estimation and I² statistics. Risk of bias was assessed using ROBINS-I across seven domains. Leave-one-out sensitivity analyses were performed for outcomes with four contributing studies; outcomes with only three contributing studies were excluded from LOO analysis given interpretability constraints. Publication bias assessment was not performed, given the limited study count. ## Key Findings: Primary Outcomes - **Wound dehiscence:** Significantly higher in GLP-1 RA users on pooled analysis across all four studies (5.2% vs. 2.9%; RR 1.62; 95% CI 1.09–2.42; p=0.017; I²=0%). LOO sensitivity analysis removing Lewis et al. 2025 attenuated the effect to non-significance (RR 1.02; 95% CI 0.46–2.26). - **Seroma:** No statistically significant difference across three studies (9.2% vs. 12.3%; RR 0.78; 95% CI 0.30–2.05; p=0.613; I²=62.7%). - **Hematoma:** No statistically significant difference across three studies (4.6% vs. 2.6%; RR 1.74; 95% CI 0.72–4.24; p=0.220; I²=0%). - **Surgical site infection:** No statistically significant difference across three studies (5.3% vs. 3.3%; RR 1.16; 95% CI 0.48–2.77; p=0.746; I²=65.6%). - **Composite SSO:** No statistically significant difference across all four studies (13.9% vs. 9.2%; RR 1.31; 95% CI 0.90–1.90; p=0.164; I²=80.7%); heterogeneity was high throughout. ## Key Findings: Secondary Outcomes and Subgroup Analyses - Lewis et al. 2025 reported higher rates of nausea, vomiting, diarrhea, delayed wound healing, hypertrophic scars, and surgical site pain in GLP-1 RA users, and recommended cautious perioperative planning, potential drug discontinuation, and nutritional optimization. These secondary outcomes were not pooled across all studies due to inconsistent reporting. - Koenig et al. 2025 restricted analysis to panniculectomy and reported lower wound dehiscence in GLP-1 RA users (1.2% vs. 2.4%), in contrast to Lewis et al. 2025. - Liang et al. 2025 reported wound dehiscence rates of 8.3% (GLP-1 RA) vs. 7.0% (controls), with a longer mean discontinuation interval of 9.6 weeks (range 0–100 weeks). - Albanese et al. 2025 was the only study to follow the ASA protocol, discontinuing GLP-1 therapy one week preoperatively. - Formal subgroup analyses by procedure type, agent, dose, or discontinuation interval were not performed; the authors cite this as a key limitation. - VTE events were infrequently reported and not pooled; no consistent differences were identified between groups. ## Results: Adverse Events and Safety Profile Gastrointestinal [adverse events](https://cedclinic.com/cbd-endocrine-effects-gynecomastia-risk-safety/) — nausea, vomiting, diarrhea — were reported as secondary outcomes by Lewis et al. 2025 at higher rates in GLP-1 RA users, but were not systematically captured or pooled across all four studies. Hypertrophic scarring and surgical site pain were also noted by Lewis et al. in GLP-1 RA users. The authors note that GLP-1 RAs may delay gastric emptying and increase aspiration risk during anesthesia, citing relevant anesthesiology guidance. Venous thromboembolism was infrequently reported and no consistent between-group differences were identified. ## Statistical Approach and Rigor The authors used Mantel-Haenszel random-effects models with REML for variance estimation, which is a defensible and commonly applied approach for heterogeneous observational data. I² was used as the primary heterogeneity metric, with pre-specified thresholds. LOO sensitivity analyses were correctly limited to outcomes with four contributing studies. The decision to forgo funnel plot and Egger’s test given the small number of studies is methodologically appropriate, though it leaves publication bias unquantified. Meta-analysis was conducted on event-level, unadjusted data because adjusted estimates were not consistently available across studies — a meaningful constraint that increases residual confounding in the pooled estimates. No formal assessment of small-study effects was performed. ## Clinical Takeaway Clinicians counseling patients on GLP-1 RA therapy who are pursuing body contouring procedures should be aware that the current pooled data suggest a possible but fragile signal for increased wound dehiscence. That signal is carried almost entirely by one large matched cohort of non-diabetic post-bariatric patients (Lewis et al. 2025), and disappears entirely in sensitivity analysis. No other wound-healing complication — seroma, hematoma, SSI, or composite SSO — reached statistical significance. The evidence is insufficient to mandate universal perioperative discontinuation, but coordination with anesthesiology and endocrinology, attention to nutritional status, and meticulous wound closure technique remain sound individualized management steps in the absence of higher-quality data. **Clinical Bottom Line:** Based on four observational studies rated at moderate to serious risk of bias, GLP-1 RA use at the time of body contouring surgery carries a statistically significant but sensitivity-analysis-fragile association with wound dehiscence, and no consistent increase in other perioperative wound complications. ## Why This Matters Clinically The intersection of GLP-1 RA use and body contouring surgery represents one of the most rapidly expanding clinical scenarios in plastic surgery. Millions of patients are losing weight on semaglutide and related agents and subsequently presenting for panniculectomy, abdominoplasty, brachioplasty, and thighplasty. Until this systematic review, no rigorous synthesis existed to guide clinicians. The findings do not establish that GLP-1 RAs are clearly unsafe in this setting, but they identify wound dehiscence as the outcome most plausibly affected — a complication associated with prolonged recovery, increased cost, reoperation, and impaired aesthetic outcomes. Equally relevant is what the data do not show: no consistent elevation in infection, seroma, hematoma, or overall SSOs. The heterogeneity across studies, the dominant influence of a single cohort, and the observational design of all included studies mean that confident perioperative guidance cannot yet be derived from this evidence base alone. ## CED Clinical Relevance At CED Clinic, patients commonly use GLP-1 receptor agonists for [weight management](https://cedclinic.com/cannabis-metabolism-weight-management-science/), metabolic optimization, and as adjuncts to comprehensive cannabis-based and integrative care plans. When these patients are also pursuing or have undergone surgical procedures — including body contouring — the perioperative safety of their GLP-1 RA regimen becomes a direct concern. This review reinforces the importance of individualized preoperative assessment, nutritional screening, and interdisciplinary coordination with surgeons and anesthesiologists when GLP-1 RA therapy is part of a patient’s active medication regimen. The absence of a robust composite SSO signal is reassuring, but the wound dehiscence data warrants a specific conversation about wound monitoring and postoperative follow-up protocols. **Clinical Insight:** For patients on semaglutide approaching body contouring surgery, the most defensible current approach is individualized risk stratification: assess nutritional status, involve anesthesiology in gastric-emptying risk planning, apply meticulous wound closure, and schedule close postoperative wound surveillance. Universal mandatory discontinuation is not yet supported by the evidence reviewed here. ## Fits What We Already Know This meta-analysis situates within a sparse but emerging literature. The authors cite Wilding et al. (NEJM 2021) establishing semaglutide’s weight-loss efficacy, and several prior case series and single-center reports on GLP-1 RAs in aesthetic contexts. The ASA consensus guidance on perioperative GLP-1 RA management, referenced by the authors, focuses primarily on aspiration risk from delayed gastric emptying, not wound healing. Prior work in other surgical specialties — including spinal fusion and total knee arthroplasty, cited by the authors — has suggested either neutral or beneficial effects of GLP-1 RAs on perioperative infection rates, which is consistent with the non-significant SSI finding here. A separate, non-included cohort by Khong et al. 2025 comparing GLP-1 RA users to post-bariatric patients without GLP-1 exposure found higher wound dehiscence and SSO rates in the bariatric group, suggesting that post-bariatric surgery status itself — not GLP-1 RA use — may be the primary driver of elevated complications in Lewis et al. 2025. ## What This Study Teaches Us In plain terms: using a GLP-1 medication like semaglutide around the time of a body-reshaping surgery does not clearly raise the overall risk of wound infections, fluid collections, or bleeding. There is a possible — but fragile — signal that wounds may be more likely to open up (dehisce) in patients on these medications, but that signal is almost entirely produced by a single large study, and vanishes when that study is removed from the analysis. The takeaway Evidence Watch Reading Tool ### Read This Paper Through Nine Different Lenses The same evidence can produce very different conclusions depending on the question being asked. Explore this study through multiple physician-guided interpretive frameworks. OVERVIEW Study finds possible but fragile link between GLP-1 RA use and increased wound dehiscence in body contouring surgery. #### Overview Badge 1: Comprehensive ReviewBadge 2: Large Patient SampleBadge 3: Sensitivity Analysis This systematic review and meta-analysis of 8,944 patients found a statistically significant association between perioperative GLP-1 RA use and wound dehiscence. However, this signal disappears in sensitivity analysis when the largest cohort is removed. No other surgical site outcomes reached significance, indicating that while there may be a potential risk with wound dehiscence, it is not consistently elevated across all studies. - GLP-1 RA use may increase wound dehiscence risk but this finding is sensitive to the inclusion of one large study. - No significant differences were observed for seroma, hematoma, or surgical site infection. - Further prospective studies are needed to guide perioperative management in patients using GLP-1 RAs. Key Insight GLP-1 RA use may increase wound dehiscence risk but this finding is not robust across all studies. #### Patient Takeaway Badge 1: Patient-CentricBadge 2: Informed Decision-MakingBadge 3: Safety First Patients using GLP-1 RAs for weight management should be aware of the potential increased risk of wound dehiscence during body contouring surgery. However, this risk is not consistently elevated across all studies. It’s important to discuss perioperative management options with your healthcare provider, including potential drug discontinuation and nutritional optimization, to minimize risks. - Discuss perioperative management options with healthcare providers. - Potential for increased wound dehiscence risk but not consistently elevated. - Consider nutritional status and meticulous wound closure techniques. Patient Advice Discuss perioperative management options with your healthcare provider to minimize risks. #### Clinician’s POV Badge 1: Evidence-BasedBadge 2: Clinical GuidanceBadge 3: [Risk Management](https://cedclinic.com/cannabis-cultivation-fires-safety-prevention/) Clinicians should be aware of the possible increased risk of wound dehiscence in patients using GLP-1 RAs undergoing body contouring surgery. However, this finding is not robust across all studies. Coordination with anesthesiology and endocrinology, attention to nutritional status, and meticulous wound closure technique are recommended steps in managing these patients. - Possible increased risk of wound dehiscence but not consistently elevated. - Coordinate with anesthesiology and endocrinology. - Attention to nutritional status and meticulous wound closure techniques. Clinical Guidance Coordinate with anesthesiology and endocrinology, and focus on nutritional status and meticulous wound closure. #### A Skeptical Read Badge 1: Critical ThinkingBadge 2: Skeptical ViewpointBadge 3: Evidence Scrutiny The study’s findings regarding increased risk of wound dehiscence with GLP-1 RA use are not robust, as the signal disappears in sensitivity analysis when a single large cohort is removed. Further prospective studies are needed to confirm these findings and provide more definitive guidance on perioperative management for patients using GLP-1 RAs. - Increased risk of wound dehiscence not robust across all studies. - Sensitivity analysis attenuates the initial finding. - Further prospective studies needed for confirmation. Critical Perspective Increased risk of wound dehiscence not robust; further studies needed. #### Study Critic Badge 1: Rigorous CritiqueBadge 2: Methodological ScrutinyBadge 3: Bias Assessment The study includes observational data with moderate to serious risk of bias, and high heterogeneity among studies limits the certainty of findings. Formal subgroup analyses by procedure type, agent, dose, or discontinuation interval were not performed, which is a key limitation. - Observational data with moderate to serious risk of bias. - High heterogeneity among studies. - Limited subgroup analyses. Methodological Critique Study has limitations due to observational design and high heterogeneity. #### Compared to Past Research Badge 1: Historical ContextBadge 2: Previous ResearchBadge 3: Evolution of Knowledge Previous research on GLP-1 RAs in surgical populations has been limited, with this study being the first systematic review and meta-analysis focusing specifically on body contouring surgery. The findings provide initial insights into the safety profile of GLP-1 RAs in this context, highlighting the need for further investigation. - First systematic review and meta-analysis on GLP-1 RAs in body contouring. - Initial insights into safety profile. - Need for further investigation. Historical Context First systematic review on GLP-1 RAs in body contouring; need for further research. #### Practical Considerations Badge 1: Practical AdviceBadge 2: Real-World ApplicationBadge 3: Immediate Usefulness Practically, clinicians should consider the potential increased risk of wound dehiscence in patients using GLP-1 RAs undergoing body contouring surgery. Coordination with anesthesiology and endocrinology, attention to nutritional status, and meticulous wound closure technique are recommended steps to minimize risks. - Consider potential increased risk of wound dehiscence. - Coordinate with anesthesiology and endocrinology. - Attention to nutritional status and meticulous wound closure. Practical Advice Coordinate with specialists and focus on nutrition and wound care. #### Future Directions Badge 1: Future DirectionsBadge 2: Research NeedsBadge 3: Emerging Trends Future research should include prospective studies to confirm the findings of this meta-analysis and provide more definitive guidance on perioperative management for patients using GLP-1 RAs. Investigating subgroup analyses by procedure type, agent, dose, or discontinuation interval could also provide valuable insights into the safety profile of GLP-1 RAs in body contouring surgery. - Prospective studies needed for confirmation. - Subgroup analyses by various factors could be valuable. - Emerging trends in perioperative management. Future Research Prospective studies and subgroup analyses needed to confirm findings. #### Misreadings & Bad-Faith Takes Badge 1: Common MisunderstandingsBadge 2: Clarification NeededBadge 3: Avoiding Errors A common misreading of the study is that GLP-1 RA use definitively increases wound dehiscence risk in body contouring surgery. However, this finding is not robust across all studies. Another potential misunderstanding is that no other perioperative complications are elevated with GLP-1 RA use, which is accurate based on the current evidence. - GLP-1 RA use does not definitively increase wound dehiscence risk. - No other perioperative complications were consistently elevated. - Avoiding misinterpretation of study findings. Misreadings to Avoid Avoid misinterpreting the robustness of increased wound dehiscence risk. Have thoughts on this? 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[Explore evidence](https://cedclinic.com/metabolic/metabolic-how-it-works/) [GLP-1 Medications and Weight Loss: What Patients Need to Know](https://cedclinic.com/glp-1-weight-loss-access-clinical-evidence/) A clinical overview of GLP-1 receptor agonists, their mechanisms, expected outcomes, and what individualized care looks like in practice. [Read article](https://cedclinic.com/glp-1-weight-loss-access-clinical-evidence/) [Cannabis for Pain Management: Matching Products to Symptoms](https://cedclinic.com/cannabis-for-pain-relief/) A practical guide to cannabinoid selection for pain, relevant for patients managing overlapping metabolic and pain concerns. [Continue reading](https://cedclinic.com/cannabis-for-pain-relief/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Physician-Led, Whole-Person Care A doctor who takes the time to truly understand you. Personal care that starts with listening and is guided by experience and ingenuity. Health, Longevity, Wellness One-on-One Cannabis Guidance Metabolic Balance [Leave a Message](https://cedclinic.com/contact/) [Metabolic Care](https://cedclinic.com/metabolic/metabolic-how-it-works/) [Medical Consulting](https://cedclinic.com/book/) [Cannabis Care](https://cedclinic.com/book/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) ### What is the main finding of the study regarding GLP-1 RA use in body contouring surgery? The study found a statistically significant association between perioperative GLP-1 RA use and wound dehiscence, but this signal disappears in sensitivity analysis when a single large cohort is removed. ### Which complications showed no statistically significant difference between GLP-1 RA users and non-users? No significant differences were observed for seroma, hematoma, surgical site infection (SSI), or composite surgical site occurrences (SSOs). ### What is the significance of the leave-one-out sensitivity analysis in this study? The leave-one-out sensitivity analysis attenuated the wound dehiscence association to non-significance when the largest cohort was removed, suggesting that the initial finding may be driven by a single large study. ### Which GLP-1 RA was most frequently reported in the studies? Semaglutide accounted for more than 99% of all GLP-1 RA prescriptions across included studies. ### What are the implications of the study’s findings for clinical practice? The evidence is insufficient to mandate universal perioperative discontinuation, but coordination with anesthesiology and endocrinology, attention to nutritional status, and meticulous wound closure technique remain sound individualized management steps. ### How was the risk of bias assessed in the included studies? Risk of bias was assessed using ROBINS-I across seven domains, with all studies rated at moderate or serious risk of bias. ### What were some of the secondary outcomes reported by Lewis et al. 2025? Lewis et al. reported higher rates of nausea, vomiting, diarrhea, delayed wound healing, hypertrophic scars, and surgical site pain in GLP-1 RA users. ### What is the current evidence regarding gastrointestinal complications with GLP-1 RAs in body contouring? Gastrointestinal adverse events such as nausea, vomiting, and diarrhea were reported at higher rates in GLP-1 RA users by Lewis et al. 2025 but were not systematically captured or pooled across all studies. ### Why was a funnel plot not included in the study? A funnel plot and Egger’s test were not performed due to the small number of studies, which is methodologically appropriate but leaves publication bias unquantified. ### What are the limitations of this meta-analysis? The study includes observational data with moderate to serious risk of bias, high heterogeneity among studies, and limited subgroup analyses by procedure type, agent, dose, or discontinuation interval. ### Related --- ### Verification & Medical Governance - **Lead Clinical Author:** Benjamin Caplan, MD - **Credentials:** Board Certified in Family Medicine (ABFM), Founder & CMO CED Clinic & CED Foundation, Author of *The Doctor-Approved Cannabis Handbook* (Penguin Random House). - **Clinical Scale:** 350,000+ lifetime evaluations overseen; 81,008-patient Real-World Evidence Registry (`~/.ced_rwe_vault.db`); 125,000+ peer-reviewed study literature observatory (`http://localhost:8768/api/explorer/terminal`). - **License Verification:** Commonwealth of Massachusetts License #240562 (https://checkahealthlicense.mass.gov/). - **NPI Registry:** 1962722637 (https://npiregistry.cms.hhs.gov/provider-view/1962722637). - **Ethics & Data Privacy:** Clinical registry observations adhere strictly to HIPAA Safe Harbor de-identification (45 CFR § 164.514(b)) and criteria for secondary research exemption under 45 CFR § 46.104(d)(4).