PHOENIX–(BUSINESS WIRE)–At this year’s American Society of Regional Anesthesia and Pain Medicine (ASRA) annual meeting, researchers at Hospital for Special Surgery (HSS) presented two studies focused on glucagon-like peptide-1 (GLP-1) agonist usage in patients undergoing surgery. GLP-1 agonists are a class of medications commonly prescribed to treat type 2 diabetes and obesity, and their therapeutic potential is extending to a range of conditions including cardiovascular and neurodegenerative diseases. These studies highlight the need for clear, evidence-based guidance as the use of GLP-1s expands.
“As GLP-1 medications increase in popularity, the effect of these drugs in patients undergoing surgery raises concerns for anesthesiologists,” says Oliver PF Panzer, MD, anesthesiologist at HSS and author of both studies. “We seek to better understand the usage and impact of GLP-1s on patients undergoing surgery so we can adapt the management of these patients to maximize their safety.”
Study: Cross Sectional Assessment of Preoperative Gastric Content with Ultrasound in Patients Taking GLP-1 Agonists
In the study “Cross Sectional Assessment of Preoperative Gastric Content with Ultrasound in Patients Taking GLP-1 Agonists,” researchers set out to explore how GLP-1 medications affect gastric emptying in patients scheduled for surgery. Food retained in the stomach can increase the risk of regurgitation and pulmonary aspiration of gastric contents, a serious, life-threatening complication during general anesthesia.
“Previous studies show patients using the GLP-1 agonist semaglutide (Ozempic, Wegovy, and Rybelsus) experience slower gastric emptying, which can result in residual gastric contents even when these patients follow standard preoperative fasting guidelines,” says Dr. Panzer. “We became concerned that patients taking GLP-1s may not be adequately protected from aspiration during anesthesia under the current guidelines.”
“The goal of this study was to look at the incidence of full stomach in patients taking GLP-1s compared to patients not taking the drugs,” says Dr. Panzer. “We also wanted to look at fasting times to detect whether people on GLP-1s who fast longer than the guidelines recommend trend toward being less full.”
In the multi-center, prospective, cross-sectional observational study, researchers used ultrasound to assess the preoperative incidence of full stomach in elective surgery patients taking weekly injectable GLP-1s compared to elective surgery patients not taking the drugs. A total of 354 patients were included in the study between August 29, 2023, and January 31, 2025. Ultrasound was performed by an anesthesiologist in the preoperative holding area, with clear fluid >1.5ml/kg or solid content indicating a full stomach. All institutions followed American Society of Anesthesiology “nothing by mouth” (NPO) fasting guidance (8 hours for heavy fatty foods; 6 hours for light meals; 2 hours for clear liquids).
Dr. Panzer and colleagues found no significant difference in the incidence of full stomach between patients taking GLP-1s and those who do not. Overall fasting times for solids tended to be longer in full patients in the GLP-1 group compared to the control group (23.73 vs 16.63 hours) but did not reach statistical significance.
“This multicenter study showed no difference in the rate of full stomachs between the GLP-1 group and the control group, which stands in contrast to what most studies have shown so far,” says Dr. Panzer. “One possible explanation for our result is that our patients report higher average fasting times (18.5 hours) than patients at other institutions. However, there may be other factors that warrant further investigation.”
“We hope to follow up this study with research that examines whether 24 hours of solid food fasting is helpful in reducing full stomach in patients on GLP-1s,” says Dr. Panzer. “Another question is whether pausing GLP-1s prior to surgery may have an impact on full stomach. Although the current guidance says to continue taking GLP-1s before surgery because stopping the drug poses its own health risks, it’s a question worth exploring.”
Study: Institutional Trends in GLP-1 Agonist Use Among Hip and Knee Arthroplasty Patients, 2021–2024
In the study, “Institutional Trends in Glucagon-Like Peptide-1 Receptor Agonist Use Among Hip and Knee Arthroplasty Patients, 2021–2024,” researchers explore the prevalence of glucagon-like peptide-1 (GLP-1) agonist use among patients undergoing primary and revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) at HSS.
“As usage of GLP-1s continues to expand in the general population, we wanted to capture the incidence and type of GLP-1 usage among patients undergoing hip and knee arthroplasty,” says Dr. Panzer.
The researchers retrospectively reviewed the records of 45,537 adult patients who underwent primary or revision THA or TKA between January 4, 2021, and December 31, 2024. Dr. Panzer and colleagues found GLP-1 use increased significantly in that period, rising from 3.69% in 2021 to 12.84% in 2024. Semaglutide and tirzepatide were the most common agents, accounting for 88% of all GLP-1 use in 2024. Higher rates of GLP-1 use were seen in patients with significant comorbidities such as hypertension, diabetes, or heart failure, and in Black patients.
“We also saw a significant decrease in the number of GLP-1 users with diabetes in this time period, suggesting that more patients are using these medications for other reasons such as weight loss,” notes Dr. Panzer.
“We will continue to examine GLP-1 usage in the surgical orthopedic population so we can ensure patients on these drugs can have surgery safely,” says Dr. Panzer. “We’re just at the beginning of this investigative journey, so there is a lot more insight to come.”
These studies contribute important early evidence to help guide emerging perioperative considerations for patients using GLP‑1 medications.
References:
Study 1: Cross Sectional Assessment of Preoperative Gastric Content with Ultrasound in Patients Taking GLP-1 Agonists
Authors: Oliver Panzer, Maya Tailor, Juliet E. Rowe, Michael Singleton, William Manson, Hari Kalagara, Nibras Bughrara, Anahita Dabo-Trubelja, Marissa Weber, Eric Heinz, Stephen C. Haskins, William P. Qiao, Miriam Sheetz, Alex Illescas, Kayla Bernstein, Mariel Maramba, Mahtab Sheikh, Jayanta Chowdhury, Sheila Carr, Tatum Gee, Eduard Shaykhinurov, Justas Lauzadis, Jashvant Poeran, Anahi Perlas
Study 2: Institutional Trends in Glucagon-Like Peptide-1 Receptor Agonist Use Among Hip and Knee Arthroplasty Patients, 2021–2024
Authors: Juliet Rowe, Maya Tailor, Alexandra Sideris, Alex Illescas, Jawad Saleh, Jashvant Poeran, Daniel Maalouf, Oliver Panzer
About HSS
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 16th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2025-2026), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2025-2026). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fifth consecutive year (2025). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
Contacts
Media:
Tracy Hickenbottom / Rachael Rennich / Lizzy Keach
[email protected]
212-606-1197
