medwireNews: Preoperative use of glucagon-like peptide (GLP)-1 receptor agonists is not associated with an increased risk for short-term postoperative aspiration pneumonia or acute respiratory failure, US study findings indicate.
In 2023, the American Society of Anesthesiologists recommended discontinuing GLP-1 receptor agonist use for up to a week before surgery due to the possible increased risk for aspiration of residual gastric content that can lead to severe complications including pneumonia, note Eric Smith (New England Baptist Hospital, Boston, Massachusetts, USA) and co-authors in JAMA Network Open.
They explain: “The basis for this concern is that GLP-1 [receptor agonists] are associated with delayed gastric emptying, resulting in increased residual gastric content and adverse gastrointestinal events, such as vomiting and gastroesophageal reflux.”
However, Smith and team believe their study findings suggest “that it might be beneficial to reassess the preoperative withholding guidelines for these medications.”
They reviewed commercial claims data for 366,476 adults (median age 53 years, 56% women) who underwent one of 14 high-volume surgical procedures, most commonly groin hernia repair, hysterectomy, and knee arthroplasty, between April 2020 and September 2022. Of these, 5931 (1.6%) patients had a preoperative prescription for dulaglutide, exenatide, liraglutide, or semaglutide within 30 days prior to surgery. These patients were more likely than nonusers to be women (59.0 vs 56.4% of men) and to have both diabetes and obesity (47.5 vs 6.8%).
Approximately half (52.8–53.1%) of the procedures in the GLP-1 receptor agonist users and nonusers were likely to be elective or urgent, 33.1–39.5% were regularly elective procedures, and 7.5–14.1% were likely to be urgent or emergent.
The researchers report that the rate of postoperative pneumonia in the 30 days after surgery was similar between GLP-1 receptor agonist users and nonusers, at 0.7% versus 0.6%, but GLP-1 receptor agonist users had a significantly higher 90-day rate of postoperative acute respiratory failure, at 13.5% versus 11.1%.
However, there was no significant difference between GLP-1 receptor agonist users and nonusers for either outcome after adjustment for patient age, sex, US region, comorbidities, including obesity, diabetes, and cardiovascular and gastroenterological disease, and whether their procedure was likely elective, urgent, or emergent.
Smith et al say that their data support an earlier study, which found that GLP-1 receptor agonist use was not associated with an increased risk for postoperative respiratory complications in people with type 2 diabetes undergoing emergency surgery. The expanded population, including both patients with and without diabetes undergoing elective, emergent, or urgent surgeries, in the current study provides “robust evidence in a generalized population,” the authors remark.
Smith and co-investigators conclude: “It is imperative to ensure the safety of surgical patients who use GLP-1 [receptor agonists], especially considering the increasing number of people using these drugs.”
They add: “[F]uture studies should investigate long-term postoperative outcomes comprehensively to ensure the safe use of GLP-1 [receptor agonists].”
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