GLP-1s not tied to higher risk for surgical complications for adults with diabetes
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Key takeaways:
- Adults with diabetes who used a GLP-1 before surgery had no higher odds for complications than those using other diabetes drugs.
- The study recommends GLP-1 therapy need not be halted before surgery.
Adults with diabetes who used a GLP-1 receptor agonist and underwent surgery requiring general anesthesia had similar odds for postsurgical complications as those receiving other oral diabetes medications, according to study data.
The findings were published in Diabetes, Obesity and Metabolism.
On June 29, 2023, the American Society of Anesthesiologists released consensus-based guidance recommending people who use GLP-1 receptor agonist drugs stop using them before surgery. Adults receiving daily GLP-1s were advised to stop the day of surgery, and those using a weekly GLP-1 were asked to stop therapy 7 days before surgery. However, David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, medical director of the Dorothy L. and James E. Frank Diabetes Research Institute of Mills-Peninsula Medical Center, noted that the guidance was based only on case reports and expert opinion. Klonoff and colleagues sought to conduct a retrospective cohort study to better assess surgical complication risks associated with diabetes medications.
“We know that when someone is taken off of diabetes medicine for surgery, they tend to have high blood sugar, and high blood sugar is associated with complications,” Klonoff told Healio. “Even as the anesthesiologists were embracing what they believed would be fewer perioperative and postoperative complications, they were also selecting a pathway that would lead to higher blood glucose levels at the time of surgery.”
Researchers obtained data from the Eversana Life Science Services dataset of 13,661 adults with diabetes who used a GLP-1 receptor agonist or another oral diabetes medication 6 months before elective surgery in which general endotracheal anesthesia was required. Surgeries included in the study were appendectomy, coronary artery bypass grafting, hernia repair, hip replacement, hysterectomy, prostatectomy, tonsillectomy, thyroidectomy and spinal fusion. Data were obtained from 2015 to March 2023. Adults who had inpatient follow-up data after surgery and 90 days of clinical history before surgery available were included. Postsurgical complications assessed in the study were postoperative decelerated gastric emptying, postoperative aspiration or pneumonitis, severe respiratory failure, postoperative hypoglycemia, inpatient mortality and 30-day mortality. Propensity score matching was used to compared surgery complication odds between adults who used GLP-1s and those using other diabetes medications.
Of the study group 2,256 used a GLP-1 before surgery. Obesity was prevalent among 76.68% of adults using a GLP-1 and 66.64% of those not using GLP-1s.
In propensity score-matched analysis, adults using a GLP-1 were less likely to have postoperative decelerated gastric emptying (OR = 0.81; 95% CI, 0.68-0.98) and antiemetic use (OR = 0.81; 95% CI, 0.67-0.97) than those not using GLP-1s. No difference in odds was observed for other complications.
In a sensitivity analysis assessing adults with diabetes and obesity, no increased risk for complications was seen for adults using GLP-1s compared with those not using GLP-1s.
Klonoff said the data from the study should be used by the American Society of Anesthesiologists to revise its recommendation. Not only may adults with diabetes have increased glucose levels if they stop GLP-1 therapy, but those who are not aware they need to stop therapy may not be able to have their procedure, according to Klonoff.
“Many people show up at the hospital for surgery and somehow it’s not conveyed to them that they’re supposed to be off of a GLP-1 receptor agonist, so they’re sent home,” Klonoff said. “They had to miss a day of work, the hospital has allocated operating room time for a procedure that’s now wasted, and the surgeon that allocated time of theirs to do the procedure, that’s wasted. It hurts the patient, the hospital and the surgeon with these last-minute cancellations.”
Reference:
Joshi GP, et al. American Society of Anesthesiologists consensus-based guidance on preoperative management of patients (adults and children) on glucagon-like peptide-1 (GLP-1) receptor agonists. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative. Published June 29, 2023. Accessed May 20, 2024.
For more information:
David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, can be reached at dklonoff@diabetestechnology.org.
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