Study: No significant link between GLP-1 drugs, postoperative aspiration pneumonia

Editor's Note

Preoperative use of GLP-1 receptor agonists was not significantly associated with an increased risk of aspiration pneumonia or acute respiratory failure after surgery, according to a March 4 report in MedPage Today.

The article focuses on a retrospective cohort study of over 366,000 surgical patients found no meaningful difference in postoperative aspiration risk between GLP-1 users and non-users. Published in JAMA Network Open, the research analyzed data from the MarketScan commercial claims database, which tracks more than 273 million U.S. patients annually. Researchers examined outcomes for patients who underwent one of 14 common surgeries between April 2020 and September 2022.

In an adjusted analysis, GLP-1 users had no statistically significant increase in aspiration pneumonia risk within 30 days of surgery (OR 0.78, 95% CI 0.57-1.06, P=0.12) or acute respiratory failure (OR 0.98, 95% CI 0.89-1.06, P=0.57), MedPage reports. GLP-1 users were more likely to be female (59% vs. 56.4%) and live in the South (51.9% vs. 45.1%). They also had higher rates of obesity (47.5% vs. 6.8%), diabetes, hypertension, and chronic kidney disease compared with non-users. The most commonly prescribed GLP-1 agent was semaglutide (42.9%), followed by dulaglutide (38.7%) and liraglutide (15.9%).

According to the article, concerns over aspiration pneumonia risk with GLP-1 agents first emerged in June 2023, when the American Society of Anesthesiologists (ASA) recommended withholding the medications before elective surgery, MedPage reports. The guidance sparked debate, and by October 2024, ASA revised its stance, stating most patients could continue taking GLP-1 drugs until the day of surgery if they followed a 24-hour liquid diet. Around the same time, the FDA added a warning to GLP-1 drug labels about pulmonary aspiration risks under general anesthesia, but it did not recommend specific preoperative precautions.

Study limitations reportedly include the reliance on prescription claims rather than confirmed medication adherence, and the lack of data on fasting duration or canceled cases due to aspiration concerns. Given the lack of association between GLP-1 use and short-term postoperative complications, the researchers suggest reconsidering preoperative GLP-1 withholding guidelines and called for further studies to clarify best practices for perioperative management.