Ozempic, Mounjaro and other GLP-1s do not increase the risk of surgical complications, according to research published May 14 in Diabetes, Obesity and Metabolism.
Nearly a year after the American Society of Anesthesiologists recommended patients skip a dose of their GLP-1s — which are medications approved for Type 2 diabetes and weight loss — because of regurgitation and aspiration risks, a review of 130 million patient records found no increased risk.
GLP-1s can delay gastric emptying, which can minimize the effect of normal fasting rules before elective surgeries. Soon after the ASA published the guidance, surgery departments across the U.S. updated their preoperative care processes to align with the guideline.
Two recent articles have poked holes in these perioperative changes.
In a study published April 22 in JAMA, Stanford Medicine researchers found no surgical risks associated with GLP-1 use among 23,000 patient records.
"Overall incidence of postoperative respiratory complications was 3.5% for those with a GLP-1 RA fill and 4% for those without," the researchers said. "Results of this study suggest that liberalizing the withholding guidelines for GLP-1 RAs preoperatively should be considered."
In an analysis of 130 million patient records, researchers evaluated peri- and post-operative gastrointestinal, respiratory, hypoglycemic and survival outcomes among hospitalized adult patients with diabetes. They looked at nine common surgeries that use general endotracheal anesthesia: appendectomy, coronary artery bypass grafting, hernia repair, hip replacement, hysterectomy, prostatectomy, tonsillectomy, thyroidectomy and spinal fusion.
Among patients who take GLP-1s, there was a lower risk of peri- and post-operative complications for decelerated gastric emptying and antiemetic use, compared to non-GLP-1 patients. The risk of ileus within seven days, aspiration/pneumonitis, hypoglycemia and 30-day mortality was also not different between cohorts.
Because of the "risk of poor control of diabetes from withholding GLP-1 drugs before surgery," the researchers suggested weighing this study's results when deciding on clinical practice guidelines.
The research was led by David Klonoff, MD, of Sutter Health's Mills-Peninsula Medical Center in Burlingame, Calif. The other study authors hailed from Stanford University School of Medicine, Thomas Jefferson University in Philadelphia, the University of Miami (Fla.), Atropos Health and the Diabetes Technology Society.