Mahmoud Luma Issa, Kehlet Henrik, Madsbad Sten, Lindberg-Larsen Martin, Varnum Claus, Jakobsen Thomas, Andersen Mikkel Rathsach, Bieder Manuel Josef, Overgaard Søren, Hansen Torben Bæk, Gromov Kirill, Jørgensen Christoffer Calov
Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Hvidovre Hospital.
Center for Fast-track Hip and Knee Replacement.
Dan Med J. 2025 Apr 9;72(5):A09240629. doi: 10.61409/A09240629.
Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are increasingly used to manage type 2 diabetes (T2D) and obesity. Recently, concerns have been raised regarding perioperative GLP1-RA management due to delayed gastric emptying and the potential risk of pulmonary aspiration. However, since no prospective data are available on surgical patients, we aimed to investigate the risk of perioperative pulmonary aspiration in patients with T2D treated with a GLP1-RA undergoing fast-track hip and knee arthroplasty.
This was a prospective observational study within a multicentre fast-track hip and knee replacement collaboration in patients with T2D with receiving GLP-1 RA. Detailed data were collected from 1 October 2022 to 1 April 2024, including perioperative GLP1-RA management, type of anaesthesia, complications and postoperative length of stay (LOS).
Among 426 patients with T2D, 19% had spinal anaesthesia without sedation, 53% had spinal anaesthesia with propofol sedation, and 26% had general anaesthesia. Data on perioperative management of GLP1-RAs were available in 93% of all patients, of whom 92% had continued their usual GLP1-RA regimen perioperatively, and the median LOS was one (IQR: 1-1) day. There were no cases with perioperative aspiration (0%; 95% confidence interval (CI): 0.0-0.9%) or LOS > 2 days (7%; 95% CI: 5-9%) potentially related to GLP1-RA-associated delayed gastric emptying.
Our results support reconsidering the arguments for prolonged withholding of GLP1-RA treatment before surgery and suggest that it may be safe to continue GLP1-RA treatment up to the day of surgery in these patients.
This study was supported financially by a grant from the NOVO NORDISK Foundation (grant number NNF21SA0073760).
gov (NCT05613439).
胰高血糖素样肽-1受体激动剂（GLP1-RAs）越来越多地用于治疗2型糖尿病（T2D）和肥胖症。最近，由于胃排空延迟以及肺误吸的潜在风险，人们对围手术期GLP1-RA的管理提出了担忧。然而，由于尚无关于手术患者的前瞻性数据，我们旨在调查接受GLP1-RA治疗的T2D患者在接受快速康复髋膝关节置换术时围手术期发生肺误吸的风险。
这是一项在多中心快速康复髋膝关节置换合作项目中对接受GLP-1 RA的T2D患者进行的前瞻性观察研究。从2022年10月1日至2024年4月1日收集详细数据，包括围手术期GLP1-RA的管理、麻醉类型、并发症和术后住院时间（LOS）。
在426例T2D患者中，19%接受了无镇静的脊髓麻醉，53%接受了丙泊酚镇静的脊髓麻醉，26%接受了全身麻醉。93%的患者有围手术期GLP1-RAs管理的数据，其中92%的患者在围手术期继续使用其常规GLP1-RA方案，中位住院时间为1（四分位间距：1-1）天。没有围手术期误吸的病例（0%；95%置信区间（CI）：0.0-0.9%）或住院时间>2天的病例（7%；95%CI：5-9%）可能与GLP1-RA相关的胃排空延迟有关。
我们的结果支持重新考虑术前长期停用GLP1-RA治疗的观点，并表明在这些患者中，直到手术当天继续使用GLP1-RA治疗可能是安全的。
本研究由诺和诺德基金会的一项赠款（赠款编号NNF21SA0073760）提供资金支持。
美国国立医学图书馆临床试验注册库（NCT05613439）。
