Written by Alex Clark
Spoon Feed
The use of pre-operative GLP-1 receptor antagonists did not increase rates of post-operative aspiration pneumonia or acute respiratory failure.
Turning the tide on semaglutide?
In 2023, the American Society of Anesthesiologists (ASA) recommended withholding glucagon-like peptide-1 receptor antagonists (GLP-1 RAs) for one week prior to elective surgery due to risk of delayed gastric emptying and aspiration. While it has been discussed, no such consensus statement exists in emergency medicine.
These authors performed a retrospective cohort study using a MarketScan commercial claims database to examine the association between pre-operative GLP-1 RAs and aspiration pneumonia. They included adult patients with receipt of a GLP-1 RA within 30 days of their index surgery (n=5,931) compared to non-user controls (n=360,545) undergoing one of 14 common surgeries prior to the 2023 ASA guidelines. After adjusting for demographics, comorbidities, and surgical acuity, there were no significant differences in rates of 30-day post-operative aspiration pneumonia (OR 0.78; 95%CI 0.57-1.06; P = .12) or 90-day acute respiratory failure (OR 0.98; 95%CI 0.89-1.06; P = .57).
The study is primarily limited by a retrospective design, reliance on ICD-10 codes and prescription data, inclusion criteria with questionable clinical significance (ie. receipt of prescription within 30 days of surgery), and 30/90-day interval assessments which may describe events that are clinically irrelevant to the surgical and anesthetic event.
How does this change my practice?
The size of the study will surely generate a lot of discussion regarding pre-operative GLP-1 RAs. However, I am cautious in interpreting claims database studies and view this article as hypothesis-generating until more prospective data is available. Additionally, perioperative medicine does not necessarily translate to emergency medicine. While it’s interesting to know that patients taking GLP-1 RA may have similar risk of aspiration as non-users, as an emergency physician, my views on procedural sedation and airway management remain the same:
- Aspiration is ALWAYS a risk in EVERY procedural sedation and intubation.
- Do not delay urgent ED procedural sedation based on fasting duration, as this has NOT demonstrated a reduction in aspiration risk (ACEP Level B Guidelines).
- Prepare for EVERY procedural sedation and intubation with double, large bore suction set-up, multiple modalities of cardiopulmonary monitoring, and advanced airway equipment and adjuncts.
Sources
Postoperative Aspiration Pneumonia Among Adults Using GLP-1 Receptor Agonists. JAMA Netw Open. 2025 Mar 3;8(3):e250081. doi: 10.1001/jamanetworkopen.2025.0081. PMID: 40036031
