Peri-operative glucagon-like peptide-1 receptor agonist use and outcomes: a national prospective multicentre cohort...

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.

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.

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.

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.