GLP-1RA use increases PONV risk, but not desaturation, in ambulatory ophthalmic surgery.
Background
The widespread adoption of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for type 2 diabetes and obesity has introduced new considerations for perioperative management. A key concern is their known effect of delayed gastric emptying, which theoretically increases the risk of pulmonary aspiration during anesthesia. While guidelines exist for major surgeries, the safety profile for continued GLP-1RA use in less invasive procedures like ambulatory ophthalmic surgery under mild-to-moderate sedation (MMS) remains less clear, particularly regarding perioperative desaturation and postoperative nausea or vomiting (PONV).
Study Design
A large retrospective, observational cohort study analyzed 45,636 visits from 30,328 adult patients undergoing ophthalmic surgery under mild-to-moderate sedation at a single institute between January 2022 and December 2024. Patients were categorized into GLP-1RA users (n=1036 patients, 1596 visits) and non-users. Primary outcomes assessed were desaturation <90% and PONV requiring antiemetic administration. Associations were determined using univariate and multivariable logistic regression, adjusted for confounders via a generalized estimating equation (GEE) approach.
Results
The study found no association between GLP-1RA use and the incidence of perioperative desaturation. The odds ratio for desaturation was 1.22 (95% CI: 0.38-3.88), with a non-significant p=0.74. However, GLP-1RA use was significantly associated with an increased likelihood of PONV requiring antiemetics. The adjusted odds ratio for PONV was 1.93 (95% CI: 1.29-2.89), indicating a nearly two-fold higher risk, with a highly significant p=0.001. Importantly, no perioperative or 24-hour postoperative aspiration events were identified in either the GLP-1RA user or non-user groups. This suggests that while GLP-1RAs increase PONV risk, the feared aspiration risk in this specific low-risk surgical context was not observed.
GLP-1RA use was associated with a 93% increased likelihood of postoperative nausea or vomiting (PONV) requiring antiemetics (OR 1.93, p=0.001).
Key Findings
- GLP-1RA use was not associated with perioperative desaturation (<90%) (OR 1.22, p=0.74).
- GLP-1RA use increased the likelihood of postoperative nausea or vomiting (PONV) by 93% (OR 1.93, p=0.001).
- No perioperative or 24-hour postoperative aspiration events were observed in either GLP-1RA users or non-users.
- The study included 45,636 visits from 30,328 patients, with 1596 visits from 1036 GLP-1RA users.
Why It Matters
This study provides crucial real-world data supporting the continued perioperative use of GLP-1RAs for patients undergoing short-duration ophthalmic surgeries under mild-to-moderate sedation, provided they meet strict pre-procedure screening. Clinicians should anticipate a higher incidence of PONV in GLP-1RA users and consider proactive antiemetic strategies or adjusted protocols. While the aspiration risk appears minimal in this specific low-risk population, the findings may not extend to higher-risk patients or more invasive surgeries. This suggests a nuanced approach where the benefits of continued GLP-1RA therapy might outweigh the minimal aspiration risk in carefully selected cases, but with a heightened awareness for PONV management.
glp-1ra
postoperative-nausea-vomiting
ponv
perioperative
ophthalmic-surgery
sedation