S1224 Double Trouble: The Effect of Opioid and GLP-1 Agonist Use on Peri- and Post-Operative Complications

Introduction: Glucagon-like peptide-1 (GLP-1) agonist use has surged for managing metabolic disease. Recent guidelines highlight concerns about perioperative aspiration risks linked to GLP-1 agonists. However, data on the incidence of aspiration or postoperative complications in this context remain limited, particularly with concomitant opiate use. This study examines perioperative aspiration and postoperative gastrointestinal complications in patients using both GLP-1 agonists and opiates. Methods: We conducted a single-center retrospective review of patients with diabetes who underwent non-emergent procedures requiring anesthesia between 1/1/2017 and 10/26/2023. Descriptive statistics summarized demographics, clinical characteristics, and outcomes. Independent samples t-tests assessed differences in continuous variables, while chi-square or Fisher’s exact tests compared categorical variables. Univariate logistic regression evaluated the effect of GLP-1 agonists and concurrent opiate use. Analyses were performed using SAS version 9.4. Results: The cohort included 20,808 procedural encounters, with 502 patients on GLP-1 agonists and 415 using both GLP-1 agonists and opiates. Patients on GLP-1 agonists and opiates had a higher odds ratio (OR) for large bowel obstruction (OR 4.37, P < 0.0001) compared to those on opiates alone (OR 3.80). Odds of ileus were similar between opiate-only users (OR 3.59) and combined users (OR 3.27) versus those not on these medications (P < 0.0001). Constipation risk was highest in GLP-1-only users (OR 4.94), followed by combined users (OR 4.72) and opiate-only users (OR 2.21, P < 0.0001). Rates of aspiration pneumonia did not differ significantly between opiate-only and combined users (P = 0.38). Conclusion: This is the first study to investigate both aspiration and gastrointestinal complications associated with GLP-1 agonists and opiates perioperatively. Our findings reinforce existing literature showing no increased aspiration risk with GLP-1 agonists. Notably, combined GLP-1 and opiate use was associated with significant increases in postoperative large bowel obstruction, ileus, and constipation, highlighting the need for careful perioperative management of these patients.