Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, California, USA.
Department of Medicine - Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, California, USA.
Diabetes Obes Metab. 2024 Aug;26(8):3128-3136. doi: 10.1111/dom.15636. Epub 2024 May 14.
To assess whether adults with diabetes on oral hypoglycaemic agents undergoing general endotracheal anaesthesia during nine common surgical procedures who are glucagon-like peptide-1 receptor agonist (GLP1-RA) users, compared with non-users, are at increased risk of six peri- and post-procedure complications.
A retrospective observational cohort analysis of over 130 million deidentified US adults with diabetes (defined as being on oral hypoglycaemic agents) from a nationally representative electronic health dataset between 1 January 2015 and 1 April 2023 was analysed. Cohorts were matched by high-dimensionality propensity scoring. We compared the odds of six peri- and postoperative complications in GLP1-RA users and non-users. A sensitivity analysis compared these odds in GLP1-RA users to non-users with diabetes and obesity. We measured the odds of (a) a composite outcome of postoperative decelerated gastric emptying, including antiemetic use, ileus within 7 days post-procedure, gastroparesis diagnosis, gastric emptying study; (b) postoperative aspiration or pneumonitis; (c) severe respiratory failure; (d) postoperative hypoglycaemia; (e) inpatient mortality; and (f) 30-day mortality.
Among 13 361 adults with diabetes, 16.5% were treated with a GLP1-RA. In the high-dimensionality propensity score-matched cohort, GLP1-RA users had a lower risk of peri- and postoperative complications for decelerated gastric emptying and antiemetic use compared with non-users. The risk of ileus within 7 days, aspiration/pneumonitis, hypoglycaemia and 30-day mortality were not different. A sensitivity analysis showed similar findings in patients with diabetes and obesity.
No increased risk of peri- and postoperative complications in GLP1-RA users undergoing surgery with general endotracheal anaesthesia was identified.
评估在接受全身气管内麻醉的九种常见手术过程中使用胰高血糖素样肽-1 受体激动剂 (GLP1-RA) 的接受口服降糖药治疗的成年糖尿病患者与非使用者相比，是否有发生六种围手术期和术后并发症的风险增加。
对 2015 年 1 月 1 日至 2023 年 4 月 1 日期间来自全国代表性电子健康数据集的超过 1.3 亿名糖尿病（定义为使用口服降糖药）美国成年人进行了回顾性观察队列分析。通过高维倾向评分对队列进行匹配。我们比较了 GLP1-RA 使用者和非使用者的六种围手术期和术后并发症的发生几率。敏感性分析比较了 GLP1-RA 使用者和非糖尿病肥胖患者的这些几率。我们测量了以下可能性：（a）术后胃排空减慢的复合结局，包括术后使用止吐药、术后 7 天内出现肠梗阻、胃轻瘫诊断、胃排空研究；（b）术后吸入或肺炎；（c）严重呼吸衰竭；（d）术后低血糖；（e）住院死亡率；（f）30 天死亡率。
在 13361 名糖尿病患者中，有 16.5%接受了 GLP1-RA 治疗。在高维倾向评分匹配的队列中，与非使用者相比，GLP1-RA 使用者的胃排空减慢和使用止吐药的围手术期和术后并发症风险较低。术后 7 天内发生肠梗阻、吸入/肺炎、低血糖和 30 天死亡率的风险没有差异。敏感性分析显示，糖尿病和肥胖患者也有类似的发现。
在接受全身气管内麻醉的手术中，GLP1-RA 使用者没有发现围手术期和术后并发症风险增加。
