AIMS: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used for glycaemic lowering, weight loss and cardio-renal protection. GLP-1RAs delay gastric emptying and are implicated in perioperative pulmonary aspiration. Cataract eye surgery is the most common outpatient surgical procedure using mild-to-moderate sedation (MMS). We evaluated whether GLP-1RA use is associated with perioperative desaturation and/or postoperative nausea or vomiting (PONV) during ambulatory ophthalmic surgery using MMS.
MATERIALS AND METHODS: A retrospective, observational cohort study of adults who underwent surgery under MMS at the Kensington Eye Institute between January 2022 and December 2024 was conducted. Patients were classified as GLP-1RA users or non-users. Primary outcomes were desaturation < 90% and PONV requiring antiemetic administration. Associations were assessed using univariate and multivariable logistic regression adjusted for risk factors and potential confounders using a generalized estimating equation (GEE) approach.
RESULTS: A total of 45 636 visits from 30 328 eligible patients were included, of which 1596 (3.5%) visits from 1036 patients were GLP-1RA users. GLP-1RA use was not associated with incidence of desaturation [OR(95% CI): 1.22 (0.38-3.88), p = 0.74]. GLP-1RA use was associated with an increased likelihood of PONV requiring antiemetics [OR(95% CI): 1.93 (1.29-2.89), p = 0.001]. No perioperative or 24-h postoperative aspiration events were identified in either group.
CONCLUSION: In this cohort, no desaturation events occurred, although PONV was more frequent amongst GLP-1RA users. These findings support the safety of continued perioperative GLP-1RA use in patients meeting strict institutional pre-procedure screening pathways for short-duration ophthalmic surgeries under MMS in an ambulatory setting but may not extend to higher risk patients excluded by institutional criteria. Future guidelines need to incorporate patient-centred symptomatology to guide clinicians in perioperative management of GLP-1RA use.
