Are patient factors associated with adverse perioperative outcomes in GLP-1 receptor agonist users? A retrospective cohort study.

BACKGROUND

Use of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RA) is increasing. Perioperative GLP-1RA continuation has adverse and beneficial effects. This retrospective cohort study aimed to identify how patient factors are associated with perioperative outcomes in GLP-1RA users.

METHODS

Adults undergoing general anesthesia, from 2015 to 2025, were selected from the TriNetX nationwide deidentified database. GLP-1RA users had three instances of GLP-1RA use within 1 month prior to surgery. GLP-1RA nonusers had no history of GLP-1RAs. Comorbidities were present within 1 year prior to surgery. Patients were matched by demographics and comorbidities like atherosclerosis, diabetes, and nicotine dependence. Adverse outcomes were assessed from operation to postoperative day 3. Respiratory complications were measured to 7 days post- operation.

RESULTS

Among eligible 2,928,513 patients, 32,261 were GLP-1RA users and 2,896,252 were matched non-GLP-1RA controls. GLP-1RA users were associated with increased nausea and vomiting (N/V) but reduced mortality, cardiovascular, respiratory, metabolic, and neurologic adverse outcomes. Pneumonitis risk was heightened only in users with asthma, chronic obstructive pulmonary disease (COPD), and heart failure. Female users had more N/V but less hyperglycemia, hypoxemia, and arrhythmia. Hispanic users had worsened hemodynamic outcomes. GLP-1RAs also demonstrated protective associations in patients with COPD or asthma.

CONCLUSIONS

GLP-1RA users generally had more favorable outcomes, but females, Hispanics, and patients with select comorbidities had increased risks. GLP-1RAs may reduce complications in patients with COPD or asthma. Clinical trials in GLP-1RA users should consider differences across comorbidities to optimize perioperative care.