Perioperative GLP1-RA management and risk of aspiration in patients with diabetes undergoing fast-track hip and knee arthroplasty

Abstract

Introduction: Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are increasingly used to manage type 2 diabetes (T2D) and obesity. Recently, concerns have been raised regarding perioperative GLP1-RA management due to delayed gastric emptying and the potential risk of pulmonary aspiration. However, since no prospective data are available on surgical patients, we aimed to investigate the risk of perioperative pulmonary aspiration in patients with T2D treated with a GLP1-RA undergoing fast-track hip and knee arthroplasty.

Methods: This was a prospective observational study within a multicentre fast-track hip and knee replacement collaboration in patients with T2D with receiving GLP-1 RA. Detailed data were collected from 1 October 2022 to 1 April 2024, including perioperative GLP1-RA management, type of anaesthesia, complications and postoperative length of stay (LOS).

Results: Among 426 patients with T2D, 19% had spinal anaesthesia without sedation, 53% had spinal anaesthesia with propofol sedation, and 26% had general anaesthesia. Data on perioperative management of GLP1-RAs were available in 93% of all patients, of whom 92% had continued their usual GLP1-RA regimen perioperatively, and the median LOS was one (IQR: 1-1) day. There were no cases with perioperative aspiration (0%; 95% confidence interval (CI): 0.0-0.9%) or LOS > 2 days (7%; 95% CI: 5-9%) potentially related to GLP1-RA-associated delayed gastric emptying.

Conclusion: Our results support reconsidering the arguments for prolonged withholding of GLP1-RA treatment before surgery and suggest that it may be safe to continue GLP1-RA treatment up to the day of surgery in these patients.

Funding: This study was supported financially by a grant from the NOVO NORDISK Foundation (grant number NNF21SA0073760).

Clinicaltrials: gov (NCT05613439).