Introduction
Peri-operative glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is associated with delayed gastric emptying. It is unclear what proportion of patients having anaesthetic care are receiving GLP-1 RAs; what strategies are used in their peri-operative management; and whether the incidence of pulmonary aspiration and/or regurgitation is greater in this population.
Methods
We performed a national prospective multicentre cohort study of adults undergoing elective or emergency procedures under the care of an anaesthetist. Patients were screened for GLP-1 RA use in the 3 months before the index procedure. Data were collected on patient, procedure, anaesthesia and outcomes, including pulmonary aspiration and regurgitation. The primary outcome was the proportion of patients receiving GLP-1 RAs. Secondary outcomes described the pre-operative management of GLP-1 RAs; anaesthesia and airway management in patients receiving GLP-1 RAs; and the incidence of pulmonary aspiration and/or regurgitation.
Results
Of 47,039 patients from 119 sites across the UK, 1348 (2.9%) reported receiving GLP-1 RAs. Peri-operative management was variable regarding drug cessation, anaesthesia and airway management. The incidence (95%CI) of pulmonary aspiration and/or regurgitation in the non-GLP-1 RA cohort was 57/45,691 (0.12% (0.09–0.16%)) and in the GLP-1 RA cohort was 19/1348 (1.41% (0.85–2.19%)); odds ratio (95%CI) 11.39 (6.47–20.05), p < 0.001. In patients receiving GLP-1 RAs, pulmonary aspiration and/or regurgitation occurred most frequently during emergence from anaesthesia.
Discussion
In this national study, 1 in 36 patients undergoing anaesthesia care received GLP-1 RAs, and their peri-operative management was variable. A range of airway management techniques aiming to reduce pulmonary aspiration risk were observed but, despite this, the incidence of pulmonary aspiration and/or regurgitation was 1 in 71 in people receiving GLP-1 RAs.
Plain Language Summary
What we did
We studied adults having surgery or other procedures with an anaesthetist at 119 hospitals across the UK. We looked at how many patients were taking GLP-1 medicines, such as those used to treat diabetes or help with weight loss (for example, Mounjaro or Wegovy). We also looked at how these medicines were managed around the time of anaesthesia and how often patients had stomach contents come back up into the mouth (regurgitation) or enter their lungs.
Why we did it
GLP-1 medicines can slow down how quickly the stomach empties. This could mean that food or liquid is still in the stomach during anaesthesia, which may increase the risk of it entering the lungs if the patient regurgitates. We wanted to find out how common GLP-1 medicine use was in patients having anaesthesia and whether these patients had a higher risk of regurgitation or stomach contents entering their lungs.
What we found
Out of 47,039 patients, 1348 (about 1 in 36) were taking GLP-1 medicines. There were big differences in how these medicines were managed before surgery and in how anaesthesia and airway care were provided. Regurgitation or stomach contents entering the lungs happened in about 1 in 71 patients taking GLP-1 medicines, compared with about 1 in 802 patients who were not taking them. This means the risk may be higher in people taking GLP-1 medicines. These events most often happened as patients were waking up from anaesthesia.