Postoperative Aspiration Pneumonia Among Adults Using GLP-1 Receptor Agonists

Abstract

Importance: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been increasingly prescribed for weight management in recent years. However, little is known about whether preoperative GLP-1 RA use is associated with a greater risk of complications after surgery.

Objective: To investigate whether preoperative GLP-1 RA use is associated with postoperative aspiration pneumonia among patients undergoing common surgical procedures.

Design, setting, and participants: This retrospective cohort study, conducted using MarketScan commercial claims databases, included patients who underwent 1 of 14 common surgical procedures from April 1, 2020, to September 30, 2022. Individuals who were younger than 18 years, underwent multiple surgical procedures, or had a preoperative history of pneumonia or acute respiratory failure in the 90 days preceding surgery were excluded. Data were analyzed from December 2023 to March 2024.

Main outcome and measures: The primary outcome was aspiration pneumonia in the 30-day postoperative period. Multivariable logistic regressions were performed, adjusting for patient and surgical characteristics.

Results: This study included 366 476 patients (median age, 53 years [IQR, 43-62 years]), of whom 56.4% were women. In the cohort, 5931 patients (1.6%) had a preoperative prescription for a GLP-1 RA. Patients using GLP-1 RAs were more likely to be female (3502 [59.0%] vs 203 288 [56.4%]) and diagnosed with both obesity and diabetes (2819 [47.5%] vs 24 635 [6.8%]) compared with nonusers. Adjusted analysis showed no significant differences in the odds of postoperative pneumonia (odds ratio, 0.78; 95% CI, 0.57-1.06; P = .12) between GLP-1 RA users and nonusers.

Conclusions and relevance: This cohort study found no significant association between the preoperative use of GLP-1 RAs and short-term postoperative aspiration pneumonia despite growing concerns about the adverse effects of these medications after surgery. This finding suggests that it may be beneficial to reassess the preoperative withholding guidelines for GLP-1 RAs.

Figure.. Sensitivity Analyses of Odds Ratios (ORs) for Aspiration Pneumonia Comparing Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) Users and Nonusers

^aIn the primary adjusted model, multivariable logistic regressions were used to adjust for patient demographics (age, sex, and geographic region), comorbidities (diabetes, obesity, hypertension, active cancer, chronic obstructive pulmonary disease, chronic kidney disease, dementia, gastroesophageal reflux disease, dysphagia, gastroparesis, myocardial infarction, heart failure, peripheral vascular disease, cerebrovascular disease, connective tissue disease, peptic ulcer disease, liver disease, hemiplegia, and AIDS), and surgical acuity. ^bModel was re-estimated by adjusting for surgical heterogeneity with indicator variables for each specific type of surgery replacing surgical acuity. ^cModel was re-estimated by incorporating anesthesia categories (“must be general anesthesia” vs “can be general anesthesia or other types of anesthesia”) for selected surgeries replacing surgical acuity.