The New Surgical Patient in the Era of GLP-1 Receptor Agonists: Perioperative Implications and Emerging Challenges for Abdominal Surgery

This is the authors' abstract. We don't add key points for this paper.

The use of glucagon-like peptide-1 (GLP-1) receptor agonists, originally developed for type 2 diabetes mellitus and now widely prescribed for obesity, has changed the profile of patients referred for surgery. These agents produce substantial weight loss, but they also delay gastric emptying and are associated with biliary, pancreatic and intestinal adverse events, with consequences for both anesthesia and abdominal surgery. This review aimed to examine the perioperative implications of GLP-1 receptor agonist use in patients undergoing abdominal surgery, focusing on the risk of residual gastric content and pulmonary aspiration, recommendations for preoperative management, and the clinical and surgical challenges posed by this emerging population. We performed a narrative review of the literature, guided by a research question structured according to the PICo framework and directed at studies on GLP-1 receptor agonists, gastric emptying, pulmonary aspiration, gastrointestinal complications and perioperative care. The evidence shows a higher prevalence of residual gastric content among users of these drugs, even after adequate fasting, although the delay in gastric emptying is moderate in magnitude and its effect on postoperative respiratory complications varies across studies. Recommendations have shifted from routine discontinuation toward individualized strategies based on risk stratification, a preoperative liquid diet and point-of-care gastric ultrasound. In abdominal surgery, additional challenges include biliary disease, pancreatitis, bowel obstruction, delayed gastrointestinal recovery and loss of lean mass. Patients receiving GLP-1 receptor agonists require a structured, multidisciplinary and individualized perioperative approach that balances anesthetic and surgical safety with preservation of the metabolic benefits of treatment.