Glucagon-like-peptide-1 (GLP-1) receptor agonist use and the risk of pulmonary aspiration in patients undergoing surgery

Glucagon-like-peptide-1 (GLP-1) receptor agonists are approved for the treatment of type II diabetes mellitus and obesity. These agents slow gastric emptying, inhibit release of glucagon, and stimulate insulin production. As GLP-1 receptor agonists slow gastric emptying, prior studies of patients undergoing esophagogastroduodenoscopy have shown that the drugs increase residual gastric contents,. Whether this results in an increased risk of pulmonary aspiration, particularly for elective surgery, remains uncertain.-However, given the theoretic concern, highly publicized guidance has recommended holding these agents in patients undergoing surgery. The objective of our study was to determine the association between use of GLP-1 receptor agonists and pulmonary aspiration among patients undergoing abdominal and thoracic surgery. [ ] [ ] [ ] [ ] ^{1 2 3 4 6 1}

The MarketScan Commercial Database was used to identify patients >18 years of age with diabetes mellitus or overweight or obesity who underwent abdominal or thoracic surgical procedures including coronary artery bypass grafting (CABG), lobectomy, pancreatectomy, thyroidectomy, colectomy, cholecystectomy, appendectomy, nephrectomy, cystectomy, hysterectomy or prostatectomy from 2015 to 2022. The cohort was limited to patients with insurance and prescription drug benefits from 3 months before through 3 months after surgery.

Patients based on receipt of GLP-1 receptor agonists including dulaglutide, exenatide, liraglutide, lixisenatide, or semaglutide within 30 days prior to the procedure. Those who had received a GLP-1 agonist but had their last prescription >30 days prior to surgery and obstetric patients were excluded. The primary outcome was aspiration pneumonia within 7 days of surgery.

A total of 392 065 patients including 15 745 (4.0%) who used GLP-1 receptor agonists and 376 320 (96.0%) who did not were identified (Table). GLP-1 agonist use rose from 2.3% in 2015 to 7.7% in 2022 (< 0.001). After PS matching, the cohort was well balanced. 1 P

The rate of pulmonary aspiration was 0.8% in those who received GLP-1 receptor agonists versus 0.7% in those who had not (= 0.61). After adjusting for other risk factors for aspiration, there was no association between GLP-1 agonist use and aspiration (OR = 1.07; 95% CI, 0.85–1.34). Similarly, there was no association between GLP-1 agonist use and aspiration for any of the individual procedures (Fig.). P 1

Among patients treated with GLP-1 receptor agonists undergoing surgery, we noted no increased risk of pulmonary aspiration. Despite limited data, the risk of pulmonary aspiration associated with GLP-1 receptor agonist use has prompted clinical guidance recommending that these agents be held prior to elective surgery. These recommendations have been widely implemented and may delay surgical procedures and necessitate changes in perioperative antidiabetic therapy. [ ] ¹

While our sample was large, we cannot exclude the possibility that GLP-1 agonists are associated with a very small increased risk of aspiration. Additionally, there may be undercapture of use of these agents or pulmonary aspiration. Despite these limitations, our data are reassuring in that there appears to be no increased risk of pulmonary aspiration among GLP-1 receptor agonist users undergoing surgery.