Risks of peri‐ and postoperative complications with glucagon‐like peptide‐1 receptor agonists

Abstract Aim To assess whether adults with diabetes on oral hypoglycaemic agents undergoing general endotracheal anaesthesia during nine common surgical procedures who are glucagon‐like peptide‐1 receptor agonist (GLP1‐RA) users, compared with non‐users, are at increased risk of six peri‐ and post‐procedure complications. Materials and Methods A retrospective observational cohort analysis of over 130 million deidentified US adults with diabetes (defined as being on oral hypoglycaemic agents) from a nationally representative electronic health dataset between 1 January 2015 and 1 April 2023 was analysed. Cohorts were matched by high‐dimensionality propensity scoring. We compared the odds of six peri‐ and postoperative complications in GLP1‐RA users and non‐users. A sensitivity analysis compared these odds in GLP1‐RA users to non‐users with diabetes and obesity. We measured the odds of (a) a composite outcome of postoperative decelerated gastric emptying, including antiemetic use, ileus within 7 days post‐procedure, gastroparesis diagnosis, gastric emptying study; (b) postoperative aspiration or pneumonitis; (c) severe respiratory failure; (d) postoperative hypoglycaemia; (e) inpatient mortality; and (f) 30‐day mortality. Results Among 13 361 adults with diabetes, 16.5% were treated with a GLP1‐RA. In the high‐dimensionality propensity score‐matched cohort, GLP1‐RA users had a lower risk of peri‐ and postoperative complications for decelerated gastric emptying and antiemetic use compared with non‐users. The risk of ileus within 7 days, aspiration/pneumonitis, hypoglycaemia and 30‐day mortality were not different. A sensitivity analysis showed similar findings in patients with diabetes and obesity. Conclusion No increased risk of peri‐ and postoperative complications in GLP1‐RA users undergoing surgery with general endotracheal anaesthesia was identified.