Association Between Glucagon-like Peptide-1 Receptor Agonist Use and Perioperative Aspiration: A Systematic Review and Meta-Analysis

Summary Background Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are known to slow gastric emptying, however the association between GLP-1 RA use and perioperative aspiration risk is not known. This systematic review and meta-analysis aimed to summarise the evidence on whether GLP-1 RA exposure is associated with (1) pulmonary aspiration in patients undergoing procedures requiring anaesthesia or sedation, or (2) increased residual gastric contents among fasted patients. Methods A search of MEDLINE, EMBASE, Web of Science, and Cochrane Central ClinicalTrials.gov and WHO ICTRP registries (updated 13 Jan 2025), and citation tracking of included studies was performed (14 Jan 2025). Studies assessing perioperative pulmonary aspiration or residual gastric contents among fasted patients who were using any form of GLP-1 RA were included. Data was extracted independently and in duplicate. Pooled odds ratios (ORs) were estimated for each outcome using random effect meta-analysis. Certainty of the evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Results Of 9,010 screened studies, 28 observational studies were included in the analysis. In a meta-analysis of 9 studies involving 304,060 individuals and 481 cases of aspiration, GLP-1RA exposure was not associated with pulmonary aspiration (OR, 1.04; 95% CI, 0.87-1.25, low certainty evidence). In a meta-analysis of 18 studies involving 165,522 individuals and 3,831 cases of residual gastric contents, GLP-1RA exposure was positively associated with residual gastric contents despite appropriate fasting (OR, 5.96; 95% CI, 3.96-8.98, low certainty evidence). In a meta-analysis of 5 studies involving 1,706 individuals and 208 cases of residual gastric contents, withholding at least one dose of GLP-1 RA prior to a procedure was associated with a lower odds of residual gastric contents (OR, 0.51; 95% CI, 0.33-0.81, very low certainty evidence). No studies measured the association between the time since last dose of GLP-1 RA and pulmonary aspiration. Conclusions Patients using GLP-1RAs are at heightened risk of presenting to surgery with residual gastric contents, though the available evidence does not indicate that this translates to an elevated risk of aspiration. Further research is needed to evaluate the risks and benefits of different strategies for managing these medications during the perioperative period.