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Importance of Timing in GLP-1 Agonist Administration Before Surgery

In a groundbreaking new study presented at the 2025 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), researchers have uncovered critical evidence pertaining to the timing of glucagon-like peptide-1 (GLP-1) receptor agonists, particularly semaglutide, which is widely known by its brand name Ozempic. This study is particularly significant in the context of patients scheduled for total joint arthroplasties, such as total knee and hip replacements, where the use of GLP-1 agonists has become increasingly prevalent due to their effectiveness in managing type 2 diabetes and obesity.

Research Focus and Findings

The focus of this study centers around understanding how the timing of the last dose of Ozempic affects anesthesia-related complications during major surgeries. Specifically, the study sheds light on issues such as delayed emergence from anesthesia, aspiration risks, and the necessity for intubation. The conclusions drawn from the research suggest that discontinuing the use of Ozempic at least 14 days prior to elective total joint replacement surgeries could significantly lower the risk of these complications.

Dr. Christopher T. Holland, the lead researcher and a total joint arthroplasty surgeon at Campbell Clinic Orthopaedics, emphasized the importance of these findings. He stated, “GLP-1 agonists can delay gastric emptying and lead to gastroparesis, resulting in food retention that can heighten anesthesia-related risks during surgery.” This study addresses a crucial gap in existing literature regarding the perioperative risks associated with GLP-1 agonist use, aiming to establish evidence-based guidelines to enhance patient safety.

Study Methodology

The study utilized data from the TriNetX Research Network, a robust multi-institutional national database. Researchers analyzed patient records from January 2018 to January 2023, focusing on participants who had undergone total knee arthroplasty (TKA) or total hip arthroplasty (THA). The cohort was divided based on when they ceased Ozempic usage relative to their surgeries, with groups categorized as follows:

• - 30 days prior (482 patients)
• - 14 days prior (591 patients)
• - 7 days prior (680 patients)
• - 5 days prior (758 patients)
• - 3 days prior (777 patients)
• - 1 day prior (706 patients)
• - No cessation (170 patients)

Comparative analysis against a control group of over 206,000 patients who did not use Ozempic was performed to gauge the impact of discontinuation timing on surgery outcomes.

Key Outcomes

The results of the analysis yielded several critical insights:

• - Stopping Ozempic three to five days before surgery was an independent risk factor for delayed emergence from anesthesia. Conversely, discontinuation at seven, 14, or 30 days prior showed no such risk.
• - A similar trend was observed with aspiration events; discontinuing three to seven days before surgery increased risk, while the 14 and 30-day groups did not.
• - Aspiration pneumonitis risk increased with cessation three to five days prior, with no heightened risk at 14 or 30 days.
• - The need for intubation was also more likely among those who stopped using Ozempic three to seven days before their procedures.
• - Notably, patients who continued Ozempic until surgery faced the highest risk across all analyzed complications.

Conclusion

The collective findings emphasize that safely discontinuing GLP-1 agonists like Ozempic at least 14 days before undergoing total joint replacement surgeries is vital. This revelation provides practical guidelines for orthopedic surgeons managing patients on these medications during the perioperative period. Dr. John R. Crockarell Jr., another surgeon involved in the study, remarked on the importance of a holistic approach to patient care, highlighting the necessity to consider both comorbidities and medication usage to optimize surgical outcomes.

This research paves the way for safer surgical practices and empowers medical professionals with essential knowledge to better manage their patients' health leading up to surgeries. As the landscape of diabetes management continues to evolve, studies like these play a pivotal role in refining protocols to serve patient safety effectively.