ACC.25 Conference Coverage

Preoperative GLP-1RA Use Linked to Lower Postoperative Mortality and Pulmonary Risks

Kate Young

Preoperative use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) may be associated with improved postoperative cardiovascular and pulmonary outcomes in patients with type 2 diabetes mellitus (T2DM), according to a new retrospective cohort analysis presented at American College of Cardiology 2025 in Chicago, IL.

Researchers found that GLP-1RA recipients experienced significantly lower 14-day postoperative mortality, aspiration, bacterial pneumonia, emergency intubation, and bronchoscopy rates compared to non-recipients. These benefits were observed both before and after the American Society of Anesthesiologists’ (ASA) June 2023 recommendation to hold GLP-1RAs preoperatively, although the range of significant outcomes narrowed post-guidance.

The use of GLP-1RAs has grown due to their known cardiovascular benefits in the T2DM population. However, in June 2023, the ASA issued a cautionary recommendation to withhold GLP-1RAs prior to surgery over concerns about delayed gastric emptying and potential aspiration risk. Given the mixed evidence to date and the broad use of these agents, further investigation into their perioperative effects was warranted.

Researchers conducted retrospective analyses using the TriNetX Research Network, examining electronic health records and claims data from two distinct timeframes: pre-guidance (June 1, 2005 to June 1, 2023) and post-guidance (September 1, 2023 to September 1, 2024). Patients with T2DM undergoing surgery were matched using propensity scores for multiple clinical and demographic variables, including surgery type, obesity, glycemic control, and medications linked to aspiration or cardiovascular risk. The primary outcomes included mortality and a range of pulmonary and cardiovascular events within 14 days postoperatively.

data from study

In the pre-guidance cohort of more than 30,000 patients, GLP-1RA use was associated with significantly reduced risk (RR) of mortality (RR, 0.59; 95% CI, 0.53–0.66), aspiration (0.53, 0.38–0.72), pneumonia (0.79, 0.69–0.90), bronchoscopy (0.69, 0.53–0.90), and emergency intubation (0.61, 0.49–0.77), with no significant differences in myocardial infarction, stroke, or pulmonary embolism. Post-guidance, mortality remained significantly lower among GLP-1RA users (0.54, 0.40–0.73). When comparing monotherapy patients, GLP-1RAs were associated with even greater reductions in mortality (0.12, 0.06–0.22), pneumonia, myocardial infarction, stroke, pulmonary embolism, emergency intubation, and improved glycemic control. However, post-guidance, only pneumonia, stroke, and serum glucose remained significantly improved.

The study was limited by both its retrospective design and reliance on administrative data, which may not capture all relevant clinical variables or adherence patterns.

“This large analysis assessed the effects of holding GLP1-RAs before surgery on postoperative outcomes. GLP1-RAs may protect against postoperative aspiration and other adverse outcomes; holding GLP1-RA may be harmful,” the authors concluded.

Reference:
Choi U Oprea DA, Sweitzer BJ, et al. Preoperatrive glucagon-like peptide 1 receptor agonists associated with improved postoperative cardiovascular outcomes. Paper presented at: American College of Cardiology; March 29-31, 2025; Chicago, IL. Accessed March 21, 2025. https://accscientificsession.acc.org/