Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Aug;26(8):3128-3136.
doi: 10.1111/dom.15636. Epub 2024 May 14.

Risks of peri- and postoperative complications with glucagon-like peptide-1 receptor agonists

David C Klonoff  1 , Sun H Kim  2 , Rodolfo J Galindo  3 , Jeffery I Joseph  4 , Valerie Garrett  5 , Saurabh Gombar  5 , Rachel E Aaron  6 , Tiffany Tian  6 , David Kerr  7
Affiliations
Observational Study

Risks of peri- and postoperative complications with glucagon-like peptide-1 receptor agonists

David C Klonoff et al. Diabetes Obes Metab. 2024 Aug.

Abstract

Aim: To assess whether adults with diabetes on oral hypoglycaemic agents undergoing general endotracheal anaesthesia during nine common surgical procedures who are glucagon-like peptide-1 receptor agonist (GLP1-RA) users, compared with non-users, are at increased risk of six peri- and post-procedure complications.

Materials and methods: A retrospective observational cohort analysis of over 130 million deidentified US adults with diabetes (defined as being on oral hypoglycaemic agents) from a nationally representative electronic health dataset between 1 January 2015 and 1 April 2023 was analysed. Cohorts were matched by high-dimensionality propensity scoring. We compared the odds of six peri- and postoperative complications in GLP1-RA users and non-users. A sensitivity analysis compared these odds in GLP1-RA users to non-users with diabetes and obesity. We measured the odds of (a) a composite outcome of postoperative decelerated gastric emptying, including antiemetic use, ileus within 7 days post-procedure, gastroparesis diagnosis, gastric emptying study; (b) postoperative aspiration or pneumonitis; (c) severe respiratory failure; (d) postoperative hypoglycaemia; (e) inpatient mortality; and (f) 30-day mortality.

Results: Among 13 361 adults with diabetes, 16.5% were treated with a GLP1-RA. In the high-dimensionality propensity score-matched cohort, GLP1-RA users had a lower risk of peri- and postoperative complications for decelerated gastric emptying and antiemetic use compared with non-users. The risk of ileus within 7 days, aspiration/pneumonitis, hypoglycaemia and 30-day mortality were not different. A sensitivity analysis showed similar findings in patients with diabetes and obesity.

Conclusion: No increased risk of peri- and postoperative complications in GLP1-RA users undergoing surgery with general endotracheal anaesthesia was identified.

Keywords: gastric emptying; glucagon‐like peptide‐1 receptor agonist; hypoglycaemia; pharmacological intervention; surgery complications.

PubMed Disclaimer

Conflict of interest statement

DCK is a consultant for Afon, Atropos Health, Better Therapeutics, Glucotrack, Lifecare, Nevro, Novo, and Thirdwayv. SHK reports a relationship with Aligos Therapeutics that includes: consulting or advisory. SHK reports a relationship with GI Dynamics that includes: consulting or advisory. RJG received research support to Emory University for investigator-initiated studies from Novo Nordisk, Dexcom and Eli Lilly and consulting/advisor/honoraria fees from Abbott, Bayer, Dexcom, Eli Lilly, and Novo Nordisk, outside of this work. RJG is partially supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) under Award Numbers P30DK111024 (RJG), K23DK123384 (RJG) and R03DK138255-01. JIJ is a founder, equity owner, and consultant to Capillary Biomedical and has received research support. VG and SG work for Atropos Health. DK has received research support from Abbott Diabetes Care. REA and TT have no disclosures.

Figures

Figure 1.
Figure 1.
Flow diagram of attrition. Legend: Abbreviation: GLP1-RA, glucagon-like peptide-1 receptor agonist.
Figure 2.
Figure 2.
High-dimensionality propensity score matched outcomes comparing users of GLP1-RAs and non-users of GLP1-RAs. Legend: The decelerated gastric emptying composite includes a) antiemetic use, b) ileus within 7 days, c) gastroparesis diagnosis, and d) gastric emptying study. Abbreviations: CI, confidence interval; GLP1-RA, glucagon-like peptide-1 receptor agonist; OR, odds ratio
See this image and copyright information in PMC

References

    1. Davies MJ, Aroda VR, Collins BS, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45(11):2753–2786. doi: 10.2337/dci22-0034 - DOI - PMC - PubMed
    1. Nauck MA, Quast DR, Wefers J, Meier JJ. GLP-1 receptor agonists in the treatment of type 2 diabetes - state-of-the-art. Mol Metab. 2021;46:101102. doi: 10.1016/j.molmet.2020.101102 - DOI - PMC - PubMed
    1. Burger L. EU regulator to discuss anaesthesia risk for weight-loss drugs | Reuters. Reuters. Published September 26, 2023. Accessed November 17, 2023. https://www.reuters.com/business/healthcare-pharmaceuticals/eu-regulator...
    1. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists | American Society of Anesthesiologists (ASA). Accessed November 17, 2023. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-...
    1. Klonoff DC, Gutierrez A, Fleming A, Kerr D. Real-World Evidence Should Be Used in Regulatory Decisions About New Pharmaceutical and Medical Device Products for Diabetes. J Diabetes Sci Technol. 2019;13(6):995–1000. doi: 10.1177/1932296819839996 - DOI - PMC - PubMed

Publication types

MeSH terms

Substances