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GLP-1s do not increase aspiration or pneumonia in surgery patients

There is no association between prescription glucagon-like peptide-1 (GLP-1) agonist medications and increased risk of aspiration or pneumonia in surgery patients, according to research by anaesthesiologists at the Icahn School of Medicine at Mount Sinai.

In their study, ‘Preoperative GLP-1 agonist use is not associated with perioperative aspiration or pneumonia: a national observational study’ (Abstract: 5488), presented at the 49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in San Diego, the study authors explained that the evidence to provide guidance for preoperative management of these drugs to prevent regurgitation and pulmonary aspiration of gastric contents is sparse limited only to several case reports. Therefore, they investigated the impact of preoperative GLP-1 agonist use on aspiration and subsequent pneumonia risk among patients undergoing various surgical procedures.

Surgical procedures included lower extremity joint replacement, hysterectomy, appendectomy and cholecystectomy. They identified preoperative use of GLP-1 agonist drugs (dulaglutide, exenatide, liraglutide, semaglutide) and using multivariable regression models they assessed the association between preoperative GLP-1 agonist use and 1) aspiration and 2) pneumonia.

Among n=186,975, n=174,277, n=116,234, and n=219,110 lower extremity joint replacement, hysterectomy, appendectomy and cholecystectomy surgeries, respectively, the preoperative use of GLP-1 agonists varied between 0.6% and 2.0%. Overall, aspiration risk was 0.20% (n=1,426 cases); this was 0.68% for pneumonia (n=4,737). In multivariable models preoperative GLP-1 use was not significantly associated with odds of aspiration (OR 1.08 CI 0.76-1.54 p=0.668) or pneumonia (OR 0.96 CI 0.78-1.17 p=0.668). A propensity score analysis yielded similar results: aspiration OR 1.38 CI 0.81-2.33 p=0.235; pneumonia OR 1.07 CI 0.80-1.42 p=0.660.

“In this observational national dataset, preoperative GLP-1 use appears not to be associated with odds of perioperative aspiration or pneumonia. Two main limitations include the use of 2021 as the most recent data and coding errors; however, we do not expect coding errors to differently affect those with and without preoperative GLP-1 use,” they authors concluded. “Despite these limitations, we believe that these data add to the current sparse evidence base. Given the very recent increases in their use continued monitoring will be prudent.”


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