INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have recently garnered increased attention due to their effectiveness in inducing marked weight loss among overweight and obese adults. Recent evidence, however, has raised concerns about a potential link between GLP-1 receptor agonist therapy and perioperative pulmonary aspiration. In this single-institution retrospective series, we aimed to quantify the incidence of intraoperative and early postoperative complications among patients taking GLP-1 RA before elective total joint arthroplasty (TJA).
METHODS: All patients who underwent primary TJA at our institution between April 2014 and October 2023 were initially screened. Patients were considered eligible for inclusion if they demonstrated consistent preoperative GLP-1 RA utilization. GLP-1 RA medication type, dosage, administration method, and treatment duration were tabulated for each patient. The primary outcomes of interest wereintraoperative anesthesia-related complications, particularly pulmonary aspiration, postoperative medical and surgical complications, and 90-day reoperation.
RESULTS: In total, 83 patients demonstrated consistent GLP-1 RA usage before primary TJA. Of these patients, 63 (75.9%) received semaglutide, 19 (22.9%) liraglutide, and 1 (1.2%) tirzepatide. No cases of acute intraoperative pulmonary aspiration were identified. Intraoperative assessment of gastric contents was not routinely performed; however, one patient was noted to have a full stomach requiring nasogastric decompression. This individual was in the dose-escalation phase of treatment, having self-administered 1 mg of semaglutide five days before surgery. Four patients (4.8%) experienced 90-day medical complications, none of which were attributed to GLP-1 RA use, and one patient (1.2%) required reoperation.
CONCLUSION: Despite recent studies suggesting an elevated risk of acute intraoperative pulmonary aspiration, our findings underscore the rare nature of intraoperative anesthesia-related adverse events in TJA patients taking GLP-1 RA.
