Risk of perioperative cardiorespiratory complications and mortality associated with preoperative glucagon-like peptide-1 receptor agonist use in type 2 diabetes mellitus: a nationwide propensity-score matched study.

Abstract

The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has raised concerns about delayed gastric emptying, pulmonary aspiration, and respiratory complications. This study aimed to investigate the association between preoperative GLP-1 RA use and perioperative respiratory complications in type 2 diabetes mellitus. We conducted a nationwide propensity-score matched cohort study using the TriNetX database to analyse adults with type 2 diabetes mellitus undergoing surgery in the USA from January 1, 2016, to December 31, 2024. The exposure of interest was use of GLP-1 RA (prescription within 90 days before surgery) compared with individuals not receiving GLP-1 RA. The primary outcome was postoperative respiratory complications within 30 days of surgery, including aspiration. After propensity matching in 296 389 matched pairs (mean [sd] age, 58 [12] yr; 57% female), 259/296 389 (0.09%) receiving GLP-1 RA before surgery had fewer respiratory complications, compared with 1017/296 389 (0.34%) individuals who were not prescribed GLP-1 RA (relative risk, 0.26 [95% confidence interval, 0.22-0.29]; P<0.0001). Pulmonary aspiration occurred in 24/296 389 (0.01%) individuals receiving GLP-1 RA, compared with 78/296 389 (0.03%) not receiving GLP-1 RA (relative risk, 0.31 [95% confidence interval, 0.20-0.49]; P<0.0001). Both long- and short-acting GLP-1 RA use was associated with fewer respiratory complications. Preoperative glucagon-like peptide-1 receptor agonists use was associated with reduced risks of perioperative respiratory complications in people with type 2 diabetes mellitus. These findings were observed in a real-world cohort, with uncertainty about whether measures were undertaken to reduce the risk of aspiration.