Comparing clinical outcomes of adults with obesity receiving tirzepatide versus bariatric metabolic surgery: A multi-institutional propensity score-matched study

Abstract

Aims

This real-world study compared clinical outcomes between tirzepatide treatment and bariatric metabolic surgery (BMS) in adults with obesity.

Methods

This retrospective cohort study used the TriNetX network to identify adults with a body mass index (BMI) ≥ 30 kg/m². Patients initiating tirzepatide treatment were compared with those undergoing BMS. The primary outcome was all-cause mortality, while secondary outcomes included major adverse cardiovascular events (MACEs) and major adverse kidney events (MAKEs). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and stratified analyses were performed based on age, sex and BMI categories.

Results

After exclusions and 1:1 propensity score matching (PSM), 84 884 matched pairs were analysed. The incidence of all-cause mortality was 0.19 per 100 person-years in the tirzepatide group compared with 0.57 in the BMS group. Tirzepatide was associated with a significantly lower risk of all-cause mortality compared with BMS (HR, 0.311; 95% CI, 0.257–0.375; p < 0.0001). The mortality benefits were consistent across age groups, genders and BMI categories. Tirzepatide also reduced the risk of MACEs (HR, 0.743; 95% CI, 0.673–0.821; p < 0.0001) and MAKEs (HR, 0.375; 95% CI, 0.336–0.419; p < 0.0001). Stratified analyses demonstrated significant reductions in primary and secondary outcomes across most categories.

Conclusion

Tirzepatide demonstrated superior clinical outcomes compared with BMS in adults with obesity, including significant reductions in all-cause mortality, MACEs and MAKEs. These findings suggest that tirzepatide may serve as an effective non-surgical alternative to BMS, with broad applicability across diverse patient populations.