Anesthesiologists’ Perspectives on GLP-1 Receptor Agonists in Elective Surgeries: A Qualitative Survey Analysis of National Data

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a novel class of drugs that have recently gained popularity for their ability to effectively manage type 2 diabetes mellitus and promote weight loss by delaying gastric emptying. The American Society of Anesthesiologists published consensus-based guidance in 2023 for the preoperative management of patients taking GLP-1 RAs. Currently, the literature to support best practice is sparse. Therefore, the purpose of this study is to gather and analyze the perspectives of currently practicing anesthesiologists regarding their experiences providing care for patients taking GLP-1 RAs and their thoughts concerning the American Society of Anesthesiologists (ASA)'s 2023 guidance. This survey study was assigned exempt status by the Michigan State University Institutional Review Board (IRB). A focus group of six practicing anesthesiologists provided free-text statements describing their thoughts and experience with GLP-1 RAs, from which common themes and preferred professional language were identified and used to develop survey items. An iterative expert validation and cognitive pretesting process was used, whereby the focus group provided feedback on draft survey items, items were edited, and the focus group re-reviewed the items repeatedly until all survey items were accurately reflective of the target research questions set by the authors. The final survey was hosted in Qualtrics software, and the survey invitation link was sent to the electronic mailing list for the author's (NCW) practice and to leadership contacts at 27 private and academic practices. The survey was available in June 2024 and remained open for responses for 11 weeks. A total of 236 responses completed the survey, with 61 responses from the author's (NCW) practice (response rate of 51.6%) and 175 responses from the national distribution. Most anesthesiologists were in their late or early careers, and 65% see patients on a GLP-1 RA at least once per week. Moreover, 66% of physicians have read the ASA's 2023 guidance document, and 66% of physicians agreed or strongly agreed that the ASA's 2023 guidance is effective at preserving patient safety. In a free-response question, most respondents commented on the 2023 guidance's lack of conclusive evidence, uncertainty of when to hold weekly GLP-1 doses, and ambiguity of using the gastric point-of-care ultrasound. This survey indicates that most survey respondents perceive the ASA's 2023 guidance on GLP-1 RAs during elective surgeries as effective in preserving patient safety. This population of physicians also frequently sees patients on a GLP-1 RA and often experiences these patients being properly instructed on and correctly holding these medications. Free-text responses expressed confusion and highlighted the lack of clinical evidence in the ASA's 2023 guidance. This survey adds support to the ASA's 2023 guidance of GLP-1 RAs during elective cases; however, many anesthesiologists expressed safety considerations for these patients, necessitating the need for future research.