Risks of peri‐ and postoperative complications with glucagon‐like peptide‐1 receptor agonists
Open accessAbstract
AIM: To assess whether adults with diabetes on oral hypoglycaemic agents undergoing general endotracheal anaesthesia during nine common surgical procedures who are glucagon-like peptide-1 receptor agonist (GLP1-RA) users, compared with non-users, are at increased risk of six peri- and post-procedure complications. MATERIALS AND METHODS: A retrospective observational cohort analysis of over 130 million deidentified US adults with diabetes (defined as being on oral hypoglycaemic agents) from a nationally representative electronic health dataset between 1 January 2015 and 1 April 2023 was analysed. Cohorts were matched by high-dimensionality propensity scoring. We compared the odds of six peri- and postoperative complications in GLP1-RA users and non-users. A sensitivity analysis compared these odds in GLP1-RA users to non-users with diabetes and obesity. We measured the odds of (a) a composite outcome of postoperative decelerated gastric emptying, including antiemetic use, ileus within 7 days post-procedure, gastroparesis diagnosis, gastric emptying study; (b) postoperative aspiration or pneumonitis; (c) severe respiratory failure; (d) postoperative hypoglycaemia; (e) inpatient mortality; and (f) 30-day mortality. RESULTS: Among 13 361 adults with diabetes, 16.5% were treated with a GLP1-RA. In the high-dimensionality propensity score-matched cohort, GLP1-RA users had a lower risk of peri- and postoperative complications for decelerated gastric emptying and antiemetic use compared with non-users. The risk of ileus within 7 days, aspiration/pneumonitis, hypoglycaemia and 30-day mortality were not different. A sensitivity analysis showed similar findings in patients with diabetes and obesity. CONCLUSION: No increased risk of peri- and postoperative complications in GLP1-RA users undergoing surgery with general endotracheal anaesthesia was identified.
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Recent studies reported no significant differences in respiratory complications between users and non-users of GLP-1 RAs.
“recent studies have reported no significant differences in respiratory complications between users and non-users of GLP-1 RAs”
From Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia (2026) · cites this paper as [57]
The Results (Outcomes) report no significant difference in aspiration/pneumonitis between GLP1-RA users and non-users (OR 0.78, 95% CI 0.29–2.09). But the same section says severe respiratory failure was too rare for matched analysis, so the broader claim about respiratory complications is not fully supported. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn people using GLP-1 RAs long-term, there is less certainty about the risk of pulmonary aspiration, particularly because the effect of tachyphylaxis on gastric emptying is unclear.
“In people using GLP-1 RAs long-term,48 there is less certainty in regard to the risk of pulmonary aspiration,49 particularly because the effect of tachyphylaxis on gastric emptying is unclear.”
From Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression (2025) · cites this paper as [49]
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- Authors
- Klonoff, D. C., Kim, S. H., Galindo, R. J., Joseph, J. I., Garrett, V., Gombar, S., Aaron, R. E., Tian, T., & Kerr, D.
- Affiliations
- Diabetes Research Institute Mills‐Peninsula Medical Center San Mateo California USA
- Stanford Medicine (US)
- University of Miami (US)
- Thomas Jefferson University (US)
- Atropos Health Palo Alto California USA
- Diabetes Technology Society (US)
- Sutter Health (US)
- Corresponding author
- Klonoff, David C.
- ORCID
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2024-05-14
- Volume
- 26
- Issue
- 8
- Pages
- 3128-3136
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- PMC
- PMC12051400
- OpenAlex
- W4396891321
- Cited by
- 58
- References
- 20
- Citations by year
- 2026: 20 · 2025: 29 · 2024: 9
- FWCI
- 19.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK123384, R03DK138255, P30DK116074, P30DK111024)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- GLP-1 receptor agonists, perioperative complications, diabetes mellitus, general anesthesia, endotracheal intubation, postoperative ileus, delayed gastric emptying, gastroparesis, postoperative aspiration, pneumonitis, respiratory failure, 30-day mortality, obesity
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Adult, Aged, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemia, Hypoglycemic Agents, Intraoperative Complications, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Risk Factors, Cohort Studies
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