Glucagon-like peptide-1 receptor agonists may need to be halted 2 weeks prior to TJA
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Key takeaways:
- Results showed 14 days may be the optimal cutoff for glucagon-like peptide-1 receptor agonists prior to hip or knee arthroplasty.
- Complication risk increased the closer use of these medications came to surgery.
DALLAS — Results presented at the American Association of Hip and Knee Surgeons Annual Meeting showed 14 days may be the optimal cutoff time for glucagon-like peptide-1 receptor agonists prior to primary hip or knee arthroplasty.
“Careful planning and optimization of patients using [glucagon-like peptide-1] GLP-1 receptor agonists is important,” Christopher T. Holland, MD, MS, orthopedic surgeon at Campbell Clinic Orthopaedics, said in his presentation. “However, we need to have firm and strict guidelines on when to stop these medications to be able to carry out primary hip and knee arthroplasty, especially in the surgery center setting.”
In a retrospective study, Holland and colleagues queried data from the TriNetX database on patients taking GLP-1 receptor agonists who underwent primary hip or knee arthroplasty procedures between 2018 and 2023. Patients taking GLP-1s were then matched with a control group of more than 200,000 patients.
Outcomes measured included delayed emergence from anesthesia, aspiration events, aspiration pneumonitis and conversion to intubation at 30 days, 14 days, 7 days and 1 day prior to surgery and continued medication through the surgery.
Holland and colleagues found there was an increased likelihood of delayed emergence from anesthesia when patients took GLP-1s within 5 days of a primary THA or TKA. In addition, Holland said patients who took GLP-1s within 7 days of surgery had an increased likelihood of an aspiration event.
“But as we got closer to surgery, that risk continued to go up,” Holland said. “And when patients did not stop it, they were five times more likely to have an aspiration event with their primary total knee or total hip arthroplasty compared to the patients who had stopped at 14 or 30 days before surgery.”
He added patients who took GLP-1s within 5 days of surgery had an increased risk for aspiration pneumonitis, while patients who took GLP-1s within 7 days of surgery had an increased risk for conversion to intubation.
Holland said patients who took GLP-1s all the way through surgery were almost seven times more likely to require conversion to intubation.
Holland also noted there were increased medical comorbidities in patients who took GLP-1s vs. the control group.
“There are further studies currently going on looking at GLP-1 receptor agonists with different side effect profiles that may not have the same effect of gastric emptying or delay of gastric emptying,” Holland said.
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Holland CT, et al. Paper 12. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 7-10, 2024; Dallas.
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