Pneumonia, Aspiration

TUESDAY, March 11, 2025 -- Stopping glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatment 14 days before total joint arthroplasty can minimize risks for complications, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 10 to 14 in San Diego. Shivan N. Chokshi, M.D., from the University of Tennessee Campbell Clinic in Memphis, and colleagues examined the association between the time of last Ozempic dose and anesthesia complications in patients who underwent total hip or knee arthroplasty from January 2018 to January 2023. Ozempic users were classified based on when they stopped medication before surgery (482, 591, 680, 758, 777, and 706 at 30, 14, seven, five, three, and one day before surgery, respectively; 170 patients continued use through surgery); the control group included 206,005 patients without prior Ozempic use. The researchers found that stopping Ozempic five days, three days, and one day prior to surgery was an independent risk factor for delayed emergence from anesthesia (odds ratios, 1.59, 1.84, and 2.23, respectively). Stopping seven days prior was a risk factor for aspiration pneumonitis (odds ratio, 1.29), with higher risks seen for stopping five days and one day prior (odds ratios, 2.74 and 2.74, respectively). Last Ozempic dose at seven days prior to surgery was identified as an independent risk factor for conversion to intubation in multivariate logistic regression (odds ratio, 1.39). Last Ozempic dose at five days, three days, and one day prior were independent risk factors for conversion to intubation (odds ratios, 2.09, 4.68, and 6.37, respectively). Patients who continued Ozempic through surgery had the highest risk for complications. "To minimize risks of delayed emergence from anesthesia, aspiration, aspiration pneumonitis, and conversion to intubation, ceasing GLP-1 RA 14 days before surgery is optimal," the authors write. Press Release More Information Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

SAN DIEGO, March 10, 2025 /PRNewswire/ -- Glucagon-like peptide-1 receptor agonists (GLP-1 agonists), such as semaglutide (e.g., Ozempic), have helped improve the management of type 2 diabetes and obesity. However, their use in the perioperative period surrounding major surgeries, like total joint arthroplasty (TJA), remains an area of growing interest and concern. A new study presented at the 2025 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) examined how the timing of a patient's last dose of Ozempic prior to total knee arthroplasty (TKA) or total hip arthroplasty (THA) influences anesthesia-related complications such as delayed emergence, aspiration, aspiration pneumonitis and conversion to intubation. The study found that discontinuing semaglutide two weeks before surgery lowered a patient's risk for these complications. "GLP-1 agonists can delay gastric emptying and cause gastroparesis (paralysis of the stomach), leading to food remaining in the stomach and increasing anesthesia-related risks," said Christopher T. Holland, MD, MS, lead author, total joint arthroplasty surgeon at Campbell Clinic Orthopaedics and a faculty instructor at the University of Tennessee Health Science Center in Memphis. "Until this past year, there was a lack of any literature reporting on the perioperative risk profile for patients who take GLP-1 agonists before surgery and the impact on surgical outcomes. With a growing number of patients using these medications for diabetes or to meet certain optimization goals before undergoing hip and knee reconstructive surgery, our aim was to establish evidence-based guidelines on when to discontinue these to enhance patient safety and surgical success." The study, "Optimal Timing for Cessation of GLP-1 Agonist Before Elective Total Hip and Knee Arthroplasty," obtained data from the TriNetX Research Network, a multi-institutional national aggregated database, to identify patients who underwent TKA or THA from January 1, 2018 to January 1, 2023. Patients who used Ozempic were categorized into cohorts based on when they discontinued Ozempic before surgery: 30 days prior to surgery - 482 patients 14 days prior to surgery - 591 patients 7 days prior to surgery - 680 patients 5 days prior to surgery - 758 patients 3 days prior to surgery - 777 patients 1 day prior to surgery - 706 patients Did not stop Ozempic prior to surgery - 170 patients These patients were compared to a control group of 206,005 with no history of Ozempic use. The cohorts were analyzed to determine the relationship between the time elapsed from their last Ozempic dose and complications from delayed emergence from anesthesia, aspiration event, aspiration pneumonitis and conversion to intubation. Highlights of the findings include: Stopping Ozempic three to five days prior to surgery was identified as an independent risk factor for delayed emergence from anesthesia. In contrast, the seven-day, 14-day, and 30-day cohorts had no independent risk factor for delayed emergence from anesthesia. Stopping Ozempic three to seven days prior to surgery was an independent risk factor for aspiration, while the 14-day and 30-day cohorts had no independent risk factor for this complication. Stopping Ozempic three to five days before surgery was identified as an independent risk factor for aspiration pneumonitis, while the seven-day, 14-day, and 30-day cohorts had no independent risk factor for aspiration pneumonitis. Stopping Ozempic three to seven days prior to surgery was an independent risk factor for conversion to intubation, while the 14-day and 30-day cohorts had no independent risk factor for this complication. Patients who did not stop Ozempic use at any time prior to surgery were at the highest risk for all complications studied. "This research provides additional evidence to suggest that discontinuing GLP-1 agonists at least 14 days before total joint replacement surgery is optimal to reduce the risk of delayed emergence from anesthesia, aspiration events, aspiration pneumonitis and conversion to intubation," said John R. Crockarell Jr., MD, MBA, FAAOS, total joint arthroplasty surgeon at Campbell Clinic Orthopaedics and a professor at the University of Tennessee Health Science Center in Memphis. "This study offers a practical guideline for surgeons managing patients on GLP-1 agonists in the perioperative period for lower extremity THA and TKA procedures. As orthopaedic surgeons, we must take a holistic approach to patient care, considering comorbidities and medications to optimize surgical outcomes. Understanding which medications can be safely continued or should be paused before surgery is key to providing comprehensive and effective care." 2025 AAOS Annual Meeting Disclosure Statement About the AAOS With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world's largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level best treat patients daily. AAOS is the source of information on bone and joint conditions, treatments, and related musculoskeletal healthcare issues; and it leads the healthcare discussion on advancing quality. Follow the AAOS on Facebook, X, LinkedIn and Instagram. 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THURSDAY, March 6, 2025 -- Preoperative glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is not associated with short-term postoperative aspiration pneumonia , according to a study published online March 4 in JAMA Network Open . Yuan-Hsin Chen, M.D., M.P.H., from Massachusetts General Hospital in Boston, and colleagues conducted a retrospective cohort study to examine whether preoperative GLP-1 RA use is associated with postoperative aspiration pneumonia among adult patients undergoing one of 14 common surgical procedures from April 1, 2020, to Sept. 30, 2022. The study included 366,476 patients; 1.6 percent had a preoperative prescription for GLP-1 RA. The researchers found that compared with nonusers, patients using GLP-1 RAs were more likely to be female (59.0 versus 56.4 percent) and diagnosed with both obesity and diabetes (47.5 versus 6.8 percent). No significant differences were seen in the odds of postoperative pneumonia between GLP-1 RA users and nonusers in an adjusted analysis (odds ratio, 0.78; 95 percent confidence interval, 0.57 to 1.06; P = 0.12). "In this cohort study, we found no significant association between GLP-1 RA use and increased short-term postoperative aspiration pneumonia," the authors write. "This finding suggests that it may be beneficial to reassess the preoperative withholding guidelines for GLP-1 RAs." One author disclosed ties to the pharmaceutical industry. Abstract/Full Text Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.