New guidance: Preoperative GLP-1s safe for surgical patients

Editor's Note

Joint guidance from key US medical associations advises that most patients on GLP-1 weight-loss medications, such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro), may safely continue these drugs before surgery, HealthDay News reported October 31.

Concerns had emerged about potential risks associated with these medications due to their tendency to delay gastric emptying, which could heighten the chance of aspiration pneumonia resulting from food regurgitation and aspiration during anesthesia, HealthDay reports. The guidance, developed by groups including the American Society of Anesthesiologists (ASA), the American Gastroenterological Association, and the American Society for Metabolic and Bariatric Surgery, addresses the balance between these risks and those associated with discontinuing the medication, such as blood sugar fluctuations in diabetic patients.

According to the article, the new recommendations emphasize individualized risk assessment. Patients are encouraged to work closely with their surgical and anesthesia teams to evaluate whether it is safe to proceed or delay a procedure. A liquid-only diet 24 hours before surgery and specific anesthesia adjustments may be used to reduce aspiration risks. High-risk patients may require further evaluation, such as point-of-care ultrasound to assess stomach contents pre-surgery.

For patients with minimal aspiration risk, continuing GLP-1 therapy is generally safe, HealthDay reports. However, the guidance recommends delaying surgery for four to eight weeks if a patient has recently begun GLP-1 treatment, as delayed gastric emptying is most pronounced in this initial period. Additionally, patients experiencing gastrointestinal side effects, such as nausea or constipation, should postpone surgery until symptoms subside.

The new recommendations were published in Surgery for Obesity and Related Diseases.