Risks of peri- and postoperative complications with glucagon-like peptide-1 receptor agonists

David C Klonoff; Sun H Kim; Rodolfo J Galindo; Jeffery I Joseph; Valerie Garrett; Saurabh Gombar; Rachel E Aaron; Tiffany Tian; David Kerr

doi:10.1111/dom.15636

Risks of peri- and postoperative complications with glucagon-like peptide-1 receptor agonists

Diabetes Obes Metab. 2024 May 14. doi: 10.1111/dom.15636. Online ahead of print.

Authors

David C Klonoff¹, Sun H Kim², Rodolfo J Galindo³, Jeffery I Joseph⁴, Valerie Garrett⁵, Saurabh Gombar⁵, Rachel E Aaron⁶, Tiffany Tian⁶, David Kerr⁷

Affiliations

¹ Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, California, USA.
² Department of Medicine - Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, California, USA.
³ Division of Endocrinology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
⁴ Department of Anesthesiology, The Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁵ Atropos Health, Palo Alto, California, USA.
⁶ Diabetes Technology Society, Burlingame, California, USA.
⁷ Center for Health Systems Research, Sutter Health, Walnut Creek, California, USA.

PMID: 38742898
DOI: 10.1111/dom.15636

Abstract

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.

Keywords: gastric emptying; glucagon‐like peptide‐1 receptor agonist; hypoglycaemia; pharmacological intervention; surgery complications.