A nationwide United Kingdom study has linked perioperative use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to a sharply elevated rate of pulmonary aspiration and regurgitation during anesthesia — a finding its authors say should drive further prospective research into how the risk can be reduced.
The work, led by Thomas E. Potter, M.B.B.S., of Guy's and St Thomas' NHS Foundation Trust in London, was published online Sept. 16 in the journal Anaesthesia, timed to coincide with the annual meeting of the Association of Anaesthetists, held Sept. 16–18 in Liverpool, England.
About one in 35 surgical patients reported GLP-1 RA use
Investigators conducted a national prospective multicenter cohort study of adults undergoing elective or emergency procedures under the care of an anesthesiologist, aiming to characterize perioperative GLP-1 RA use and the outcomes associated with it.
Across 119 sites in the United Kingdom, 47,039 patients were included. Of those, 2.9 percent reported that they were receiving GLP-1 RAs — a drug class originally developed for type 2 diabetes and now widely used for weight management.
The study also found wide variation in clinical practice. With respect to drug cessation, anesthesia and airway management, perioperative management was variable from case to case, indicating that no single standardized approach was in place across the participating hospitals.
A stark difference between the two groups
The central safety finding concerned two closely related airway events. In the cohort not receiving GLP-1 RAs, the incidence of pulmonary aspiration and/or regurgitation was 0.12 percent. In the GLP-1 RA cohort, the figure was 1.41 percent — an odds ratio of 11.39.
That comparison translates into roughly eleven-fold higher odds of the complication among patients who reported taking the drugs, based on the study's statistical analysis.
- Non-GLP-1 RA cohort: 0.12 percent incidence of pulmonary aspiration and/or regurgitation.
- GLP-1 RA cohort: 1.41 percent incidence of pulmonary aspiration and/or regurgitation.
- Odds ratio: 11.39.
- Reported GLP-1 RA use: 2.9 percent of 47,039 patients drawn from 119 UK sites.
Timing points to emergence from anesthesia
When the events occurred may prove as instructive as how often they occurred. Among patients receiving GLP-1 RAs, pulmonary aspiration and/or regurgitation happened most often during emergence from anesthesia — the period in which patients are waking and protective airway reflexes are returning.
That timing detail is relevant to how anesthesiologists think about monitoring and airway protection, and it is one of the factors the study's authors point to when calling for follow-up work.
Inside the study design
The investigation was a national prospective multicenter cohort study rather than a randomized trial. Adults booked for elective or emergency procedures under an anesthesiologist's care were enrolled at 119 sites across the United Kingdom. Medication use was captured through patients' reports of receiving GLP-1 RAs, and the research team tracked outcomes including pulmonary aspiration and regurgitation.
Because the authors set out to examine both perioperative GLP-1 RA use and outcomes, the study offers a broad picture of real-world practice rather than the tightly controlled conditions of an experimental design. That choice helps explain the wide variation in how drug cessation, anesthesia and airway management were handled from site to site.
Authors call for prospective studies
Writing in Anaesthesia, the researchers concluded that the findings justify additional research. "These data warrant further prospective studies to determine interventions that may mitigate risks of pulmonary aspiration and improve patient outcomes," the authors write.
The emphasis on prospective design reflects the limits of what an observational cohort can establish. The study captures associations between reported GLP-1 RA use and airway events; it does not by itself demonstrate that the medications cause the complication, nor does it identify which patients face the greatest risk or which perioperative strategies might change the picture.
Questions that remain open
The results leave several issues unresolved, and the authors' call for further work points toward them directly:
- Which interventions, if any, might mitigate the risk of pulmonary aspiration in this patient group.
- How different approaches to pausing GLP-1 RAs before surgery affect outcomes, given the variability in perioperative management observed across sites.
- Whether particular subgroups of patients account for a disproportionate share of the airway events.
- What role the timing of the last dose before an operation plays in the events seen during emergence from anesthesia.
Why the finding reaches beyond the operating room
GLP-1 RAs have moved within a few years from a specialist diabetes therapy to one of the most widely prescribed classes of medication in the world. As the number of people taking them grows, so does the number who will eventually need surgery — whether an elective procedure or an emergency one.
Anesthesiologists have been debating how best to manage that population, particularly the question of whether and for how long patients should interrupt their medication before an operation. The UK data underline why the question has drawn attention: perioperative management in this study was not uniform, and the complication rate recorded in the GLP-1 RA group was more than ten times that of the comparison group.
The bottom line
In a study spanning 119 UK sites and 47,039 patients, 2.9 percent reported GLP-1 RA use during the perioperative period. Pulmonary aspiration and/or regurgitation occurred in 0.12 percent of patients not taking the drugs and 1.41 percent of those who were, an odds ratio of 11.39, with events clustering around emergence from anesthesia.
The authors say the results support further prospective investigation aimed at identifying interventions that could lower the risk of pulmonary aspiration and improve outcomes for surgical patients. The study appears in Anaesthesia (DOI: 10.1111/anae.70380).
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
