Optimal timing for cessation of GLP-1 receptor agonists prior to TJA may be 14 days
Key takeaways:
- Patients who stopped GLP-1s 7 days prior to surgery or earlier had increased rates of anesthesia complications.
- Stopping GLP-1s 14 days prior to TJA was linked to a reduced anesthesia complication risk.
SAN DIEGO — Stopping GLP-1 receptor agonists 14 days prior to total hip or knee arthroplasty may reduce several key risk factors associated with anesthesia complications, according to results presented here.
“Specifically for semaglutide, stopping that medication 14 days before surgery is safest based upon the dataset that we have to minimize your risks with anesthesia, especially when delivering surgical care in the outpatient setting,” Christopher T. Holland, MD, MS, total joint arthroplasty faculty at Campbell Clinic Orthopedics, told Healio.
Holland and colleagues queried the TriNetX database for patients who underwent either THA or TKA between 2018 and 2023 to evaluate the relationship between patients’ last dose of GLP-1 receptor agonists and anesthesia complications. Patients were categorized into groups depending on whether they stopped taking GLP-1s 30 days, 14 days, 7 days, 5 days, 3 days or 1 day prior to surgery.
Holland and colleagues found patients who stopped taking GLP-1s 7 days prior to TJA or earlier had increased risks for aspiration and aspiration pneumonitis. In addition, stopping GLP-1s 5 days prior to surgery or earlier was an independent risk factor for delayed emergence from anesthesia.
However, Holland said stopping GLP-1s 14 days prior to THA or TKA surgery was associated with reduced patient risks for delayed emergency from anesthesia, aspiration, aspiration pneumonitis and conversion to intubation.
“The difficult thing with this is a lot of us do not have that contact point 2 weeks before surgery,” Holland said. “So, now when we are seeing patients in clinic, it is just another thing that we have to be armed with in terms of evidence and knowledge to be able to help that patient get through their entire care event up to and through surgery safely.”
He added, “This study definitely adds to the literature from a semaglutide standpoint, but we are going to have to look at other agonists and see what the different side-effect profiles are of those medications, as well as maybe different time frames for each specific medication.”
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Holland CT, et al. Paper 97. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.