Concerns about gastric and respiratory complications during surgery in patients who are taking Ozempic and other GLP-1 receptors used to lower blood glucose levels may be unwarranted, according to a study by a team of Stanford Medicine researchers.

The American Society of Anesthesiologists in June 2023 recommended that patients on these drugs—typically diabetics and those trying to lose weight—should stop taking them a week prior to elective surgery. The society pointed to reports that the drugs increased the risk of regurgitation and pulmonary aspiration while under general anesthesia. 

New research by a team of Stanford clinicians, however, finds the concerns appear to be unmerited. Using insurance claims from a large national database of about 250 million individuals younger than 65, they evaluated all patients with type 2 diabetes who had been prescribed a GLP-1 RA and those who were not.

They found overall incidence of postoperative respiratory complications was 3.5% for those taking one of the drugs and 4% for those who had not been prescribed the drugs, concluding there was no significant difference between the two groups. Their findings do not apply to patients using GLP-1 receptor agonists undergoing procedures under light or moderate sedation without an anesthesiologist or other advanced airway practitioner.

“We were surprised by our findings given many case reports of patients who had recently taken GLP-1 receptor agonists and had a large volume of gastric contents found under anesthesia, even if they had appropriately withheld these medications and fasted for the recommended times before surgery,” said Anjali Dixit, MD, MPH, a pediatric anesthesiologist and clinical and postdoctoral scholar in anesthesiology, perioperative and pain medicine at Stanford Medicine. “These reports had raised concerns that patients using these medications would have a much higher risk of pulmonary aspiration under anesthesia, which is a serious and potentially fatal complication.”

Dixit is the lead author of the study; her Stanford Medicine co-authors are Brian Bateman, MD, MS, Mary Hawn, MD, MPH, Michelle Odden, PhD, and Eric Sun, MD, PhD, who is the senior author of the study.

In their research letter published in JAMA, the researchers noted the potential negative impact of going off these medications before surgery. 

“Although preoperative medication guidelines can prevent complications, withholding medications can also result in adverse effects,” they wrote. “Furthermore, associated logistical burdens can result in surgical cancellations, significant care delays, and financial losses from unused operating time.”