Data cast doubt on recommendation to delay weight-loss meds prior to surgery

Editor's Note

A recent analysis of insurance claims data suggests weight-loss medications like Ozempic (semaglutide), Trulicity (dulaglutide), and other glucagon-like peptide-1 (GLP-1) receptor agonists do not increase risks associated with undergoing anesthesia. As reported April 22 in MedPage Today, these finding that contradicts a June 2023 recommendation from the American Society of Anesthesiologists to avoid these drugs prior to surgery.

Published in JAMA and conducted by researchers at Stanford University School of Medicine in California, the study focused on patients with diabetes undergoing surgery the same day as an emergency department visit, “a scenario where the recommended withholding of a GLP-1 drug would be unlikely,” MedPage reports. They found that patients on GLP-1 agents experienced similar rates of postoperative respiratory complications as those taking other antidiabetic drugs.

"We were surprised by our findings given the case reports of large-volume emesis, as well as other studies showing increased gastric volumes, in appropriately fasted patients who had used GLP-1 receptor agonists," lead researcher Anjali Dixit, MD, MPH,  told MedPage Today. "These studies had raised concerns that patients who had recently taken a GLP-1 receptor agonist would have a much higher risk of pulmonary aspiration under anesthesia, which is a serious and potentially fatal complication."

Based on the new findings, it may in fact be safe to carry on with surgery even if a patient using a GLP-1 agonist did not follow the medication withholding guidelines, Dixit said. "The current recommendation to withhold most GLP-1 receptor agonists for a week before surgery is logistically burdensome, requiring patients to be contacted over a week ahead of time," Dixit pointed out. "If they don't follow the guidelines, their surgery may be canceled—and canceled surgeries are sometimes never rescheduled. This can lead to patient harm."