Study Finds GLP-1 Weight Loss Meds Safe Before Surgery

Recent concerns regarding the safety of using GLP-1 medications such as Ozempic and Wegovy before surgery have been dispelled by a new review. These medications, known for their role in weight loss, were feared to slow down gastric emptying, potentially increasing the risk of food particles being aspirated into the lungs during anesthesia.

The apprehension was based on the fact that GLP-1 medications affect gastrointestinal motility, which could theoretically cause food to linger in the stomach longer than normal. This led to fears that patients might choke or experience pulmonary aspiration while under anesthesia. However, the latest review of data from 15 randomized studies indicates only a minor impact on gastric emptying, which is not significant enough to pose a risk during surgery.

Dr. Walter Chan, the senior author of the study and director of the Center of Gastrointestinal Motility at Brigham and Women's Hospital in Boston, explained, "While GLP-1 medications do influence gastrointestinal tract movement, the extent of their impact seems much less significant than previously thought."

The findings, published in the June issue of the American Journal of Gastroenterology, suggest that it is safe for patients to continue these medications before undergoing procedures requiring anesthesia or sedation. Minor precautions, such as abstaining from solid food for a day, can help minimize any potential risk of aspiration.

Guidelines around the use of GLP-1 medications before surgery have been inconsistent. The American Society of Anesthesiologists advises patients to discontinue GLP-1 medications up to a week before elective procedures, while the American Gastroenterological Association recommends proceeding with planned surgeries but following standard pre-surgery precautions, such as avoiding solid food.

The new review analyzed data from 652 participants across 15 randomized trials, measuring gastric emptying times in patients on various GLP-1 medications. The results showed that while GLP-1 medications did slow gastric emptying, it was only by an average of 36 minutes, which is not enough to warrant significant concerns. Importantly, none of the participants in these studies experienced pulmonary aspiration due to delayed gastric emptying.

Dr. Brent Hiramoto, the lead author of the study and a senior gastroenterology fellow at Brigham and Women’s Hospital, emphasized the need to update current guidelines based on these findings. "We recommend that guidelines be updated with the following precautions for GLP-1 RA users undergoing endoscopic procedures: continue therapy, follow a liquid-only diet the day prior, and adhere to standard pre-anesthesia fasting," Hiramoto stated. "Until more data on solid diets is available, a conservative approach with a liquid diet while continuing therapy is advisable."

The study's findings provide reassurance to both patients and healthcare providers, suggesting that GLP-1 medications can be safely used prior to surgeries, provided that appropriate pre-surgery precautions are taken. This clarification helps address the mixed recommendations and offers a more unified approach, ensuring patient safety while accommodating the benefits of these weight-loss drugs.

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