New Guidelines for GLP-1 Drugs During Surgery Address Safety Concerns

The Society for Perioperative Assessment and Quality Improvement (SPAQI) has published comprehensive new guidelines addressing a growing clinical challenge: how to safely manage the millions of patients taking GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) when they need surgery.

These medications, originally developed for diabetes but now widely prescribed for weight loss, work by slowing gastric emptying - the rate at which food leaves the stomach. This mechanism raises concerns about increased aspiration risk during anesthesia, as patients may have food remaining in their stomachs longer than expected, even after standard fasting periods.

The expert panel used a modified Delphi process and systematic literature review to develop evidence-based recommendations. Their guidelines address two critical questions: when patients should stop taking these medications before surgery, and how long they should fast from food and liquids. Previous recommendations from different medical societies had varied significantly, creating confusion for clinicians.

The consensus addresses both medication management and preoperative fasting protocols, recognizing that different GLP-1 agonists have varying durations of action. The guidelines also consider the balance between surgical safety and the metabolic benefits these medications provide, particularly for patients with diabetes who may experience blood sugar fluctuations when stopping treatment.

These recommendations come at a crucial time, as GLP-1 agonist use has exploded, with millions of Americans now taking these medications. The guidelines provide much-needed standardization for perioperative care, potentially improving safety outcomes while ensuring patients can continue benefiting from these transformative treatments for obesity and diabetes management.