Postoperative Aspiration Pneumonia Among Adults Using GLP-1 Receptor Agonists

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been increasingly prescribed for weight management in recent years. However, little is known about whether preoperative GLP-1 RA use is associated with a greater risk of complications after surgery.

To investigate whether preoperative GLP-1 RA use is associated with postoperative aspiration pneumonia among patients undergoing common surgical procedures.

This retrospective cohort study, conducted using MarketScan commercial claims databases, included patients who underwent 1 of 14 common surgical procedures from April 1, 2020, to September 30, 2022. Individuals who were younger than 18 years, underwent multiple surgical procedures, or had a preoperative history of pneumonia or acute respiratory failure in the 90 days preceding surgery were excluded. Data were analyzed from December 2023 to March 2024.

The primary outcome was aspiration pneumonia in the 30-day postoperative period. Multivariable logistic regressions were performed, adjusting for patient and surgical characteristics.

This study included 366 476 patients (median age, 53 years [IQR, 43-62 years]), of whom 56.4% were women. In the cohort, 5931 patients (1.6%) had a preoperative prescription for a GLP-1 RA. Patients using GLP-1 RAs were more likely to be female (3502 [59.0%] vs 203 288 [56.4%]) and diagnosed with both obesity and diabetes (2819 [47.5%] vs 24 635 [6.8%]) compared with nonusers. Adjusted analysis showed no significant differences in the odds of postoperative pneumonia (odds ratio, 0.78; 95% CI, 0.57-1.06; P = .12) between GLP-1 RA users and nonusers.

This cohort study found no significant association between the preoperative use of GLP-1 RAs and short-term postoperative aspiration pneumonia despite growing concerns about the adverse effects of these medications after surgery. This finding suggests that it may be beneficial to reassess the preoperative withholding guidelines for GLP-1 RAs.