Peri‐operative glucagon‐like peptide‐1 receptor agonist use and outcomes: a national prospective multicentre cohort study

Summary Introduction Peri‐operative glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA) use is associated with delayed gastric emptying. It is unclear what proportion of patients having anaesthetic care are receiving GLP‐1 RAs; what strategies are used in their peri‐operative management; and whether the incidence of pulmonary aspiration and/or regurgitation is greater in this population. Methods We performed a national prospective multicentre cohort study of adults undergoing elective or emergency procedures under the care of an anaesthetist. Patients were screened for GLP‐1 RA use in the 3 months before the index procedure. Data were collected on patient, procedure, anaesthesia and outcomes, including pulmonary aspiration and regurgitation. The primary outcome was the proportion of patients receiving GLP‐1 RAs. Secondary outcomes described the pre‐operative management of GLP‐1 RAs; anaesthesia and airway management in patients receiving GLP‐1 RAs; and the incidence of pulmonary aspiration and/or regurgitation. Results Of 47,039 patients from 119 sites across the UK, 1348 (2.9%) reported receiving GLP‐1 RAs. Peri‐operative management was variable regarding drug cessation, anaesthesia and airway management. The incidence (95%CI) of pulmonary aspiration and/or regurgitation in the non‐GLP‐1 RA cohort was 57/45,691 (0.12% (0.09–0.16%)) and in the GLP‐1 RA cohort was 19/1348 (1.41% (0.85–2.19%)); odds ratio (95%CI) 11.39 (6.47–20.05), p < 0.001. In patients receiving GLP‐1 RAs, pulmonary aspiration and/or regurgitation occurred most frequently during emergence from anaesthesia. Discussion In this national study, 1 in 36 patients undergoing anaesthesia care received GLP‐1 RAs, and their peri‐operative management was variable. A range of airway management techniques aiming to reduce pulmonary aspiration risk were observed but, despite this, the incidence of pulmonary aspiration and/or regurgitation was 1 in 71 in people receiving GLP‐1 RAs.