Chen Yuan-Hsin, Zink Thomas, Chen Ya-Wen, Nin Darren Z, Talmo Carl T, Hollenbeck Brian L, Grant Andrew R, Niu Ruijia, Chang David C, Smith Eric L
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston.
Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston.
JAMA Netw Open. 2025 Mar 3;8(3):e250081. doi: 10.1001/jamanetworkopen.2025.0081.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been increasingly prescribed for weight management in recent years. However, little is known about whether preoperative GLP-1 RA use is associated with a greater risk of complications after surgery.
To investigate whether preoperative GLP-1 RA use is associated with postoperative aspiration pneumonia among patients undergoing common surgical procedures.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study, conducted using MarketScan commercial claims databases, included patients who underwent 1 of 14 common surgical procedures from April 1, 2020, to September 30, 2022. Individuals who were younger than 18 years, underwent multiple surgical procedures, or had a preoperative history of pneumonia or acute respiratory failure in the 90 days preceding surgery were excluded. Data were analyzed from December 2023 to March 2024.
The primary outcome was aspiration pneumonia in the 30-day postoperative period. Multivariable logistic regressions were performed, adjusting for patient and surgical characteristics.
This study included 366 476 patients (median age, 53 years [IQR, 43-62 years]), of whom 56.4% were women. In the cohort, 5931 patients (1.6%) had a preoperative prescription for a GLP-1 RA. Patients using GLP-1 RAs were more likely to be female (3502 [59.0%] vs 203 288 [56.4%]) and diagnosed with both obesity and diabetes (2819 [47.5%] vs 24 635 [6.8%]) compared with nonusers. Adjusted analysis showed no significant differences in the odds of postoperative pneumonia (odds ratio, 0.78; 95% CI, 0.57-1.06; P = .12) between GLP-1 RA users and nonusers.
This cohort study found no significant association between the preoperative use of GLP-1 RAs and short-term postoperative aspiration pneumonia despite growing concerns about the adverse effects of these medications after surgery. This finding suggests that it may be beneficial to reassess the preoperative withholding guidelines for GLP-1 RAs.
近年来，胰高血糖素样肽-1受体激动剂（GLP-1 RAs）在体重管理方面的处方量越来越大。然而，术前使用GLP-1 RAs是否会增加术后并发症的风险，目前知之甚少。
探讨在接受常见外科手术的患者中，术前使用GLP-1 RAs是否与术后吸入性肺炎有关。
设计、设置和参与者：这项回顾性队列研究使用MarketScan商业索赔数据库，纳入了2020年4月1日至2022年9月30日期间接受14种常见外科手术之一的患者。排除年龄小于18岁、接受过多次外科手术或术前90天内有肺炎或急性呼吸衰竭病史的个体。数据于2023年12月至2024年3月进行分析。
主要结局是术后30天内发生的吸入性肺炎。进行多变量逻辑回归分析，并对患者和手术特征进行调整。
本研究纳入了366476例患者（中位年龄53岁[四分位间距，43 - 62岁]），其中56.4%为女性。在该队列中，5931例患者（1.6%）术前开具了GLP-1 RA处方。与未使用者相比，使用GLP-1 RAs的患者更可能为女性（3502例[59.0%]对203288例[56.4%]），且被诊断为肥胖和糖尿病（2819例[47.5%]对24635例[6.8%]）。调整分析显示，GLP-1 RA使用者和未使用者术后肺炎的几率无显著差异（优势比，0.78；95%置信区间，0.57 - 1.06；P = 0.12）。
尽管人们越来越担心这些药物在术后的不良反应，但这项队列研究发现，术前使用GLP-1 RAs与术后短期吸入性肺炎之间无显著关联。这一发现表明，重新评估GLP-1 RAs的术前停用指南可能是有益的。
