Perioperative GLP1-RA management and risk of aspiration in patients with diabetes undergoing fast-track hip and knee arthroplasty.

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Danish medical journal Pub Date : 2025-04-09 DOI:10.61409/A09240629

Luma Issa Mahmoud, Henrik Kehlet, Sten Madsbad, Martin Lindberg-Larsen, Claus Varnum, Thomas Jakobsen, Mikkel Rathsach Andersen, Manuel Josef Bieder, Søren Overgaard, Torben Bæk Hansen, Kirill Gromov, Christoffer Calov Jørgensen

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引用次数: 0

Abstract

Introduction: Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are increasingly used to manage type 2 diabetes (T2D) and obesity. Recently, concerns have been raised regarding perioperative GLP1-RA management due to delayed gastric emptying and the potential risk of pulmonary aspiration. However, since no prospective data are available on surgical patients, we aimed to investigate the risk of perioperative pulmonary aspiration in patients with T2D treated with a GLP1-RA undergoing fast-track hip and knee arthroplasty.

Methods: This was a prospective observational study within a multicentre fast-track hip and knee replacement collaboration in patients with T2D with receiving GLP-1 RA. Detailed data were collected from 1 October 2022 to 1 April 2024, including perioperative GLP1-RA management, type of anaesthesia, complications and postoperative length of stay (LOS).

Results: Among 426 patients with T2D, 19% had spinal anaesthesia without sedation, 53% had spinal anaesthesia with propofol sedation, and 26% had general anaesthesia. Data on perioperative management of GLP1-RAs were available in 93% of all patients, of whom 92% had continued their usual GLP1-RA regimen perioperatively, and the median LOS was one (IQR: 1-1) day. There were no cases with perioperative aspiration (0%; 95% confidence interval (CI): 0.0-0.9%) or LOS > 2 days (7%; 95% CI: 5-9%) potentially related to GLP1-RA-associated delayed gastric emptying.

Conclusion: Our results support reconsidering the arguments for prolonged withholding of GLP1-RA treatment before surgery and suggest that it may be safe to continue GLP1-RA treatment up to the day of surgery in these patients.

Funding: This study was supported financially by a grant from the NOVO NORDISK Foundation (grant number NNF21SA0073760).

Trial registration:

Clinicaltrials: gov (NCT05613439).

查看原文本刊更多论文

快速通道髋关节和膝关节置换术中糖尿病患者围手术期GLP1-RA管理和误吸风险

胰高血糖素样肽-1受体激动剂（GLP1-RAs）越来越多地用于治疗2型糖尿病（T2D）和肥胖。最近，由于胃排空延迟和肺误吸的潜在风险，人们对围手术期GLP1-RA的管理提出了关注。然而，由于没有手术患者的前瞻性数据，我们的目的是研究GLP1-RA治疗的T2D患者行快速通道髋关节和膝关节置换术的围手术期肺误吸的风险。方法：这是一项多中心快速通道髋关节和膝关节置换术合作的前瞻性观察研究，用于接受GLP-1 RA的T2D患者。从2022年10月1日至2024年4月1日收集详细数据，包括围手术期GLP1-RA管理、麻醉类型、并发症和术后住院时间（LOS）。结果：426例T2D患者中，19%行脊髓麻醉不加镇静，53%行脊髓麻醉加异丙酚镇静，26%行全身麻醉。93%的患者可获得GLP1-RA围手术期管理数据，其中92%的患者围手术期继续其常规GLP1-RA方案，中位LOS为1 （IQR: 1-1）天。无围手术期误吸病例(0%；95%置信区间（CI）： 0.0-0.9%)或LOS 2天(7%；95% CI: 5-9%)可能与glp1 - ra相关的胃排空延迟有关。结论：我们的研究结果支持重新考虑术前延长GLP1-RA治疗的争论，并建议在这些患者中继续GLP1-RA治疗直至手术当天可能是安全的。经费：本研究由诺和诺德基金会资助（资助号NNF21SA0073760）。试验注册：Clinicaltrials: gov （NCT05613439）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Danish medical journal MEDICINE, GENERAL & INTERNAL-

CiteScore

2.30

自引率

6.20%

发文量

审稿时长

3-8 weeks

期刊介绍： The Danish Medical Journal (DMJ) is a general medical journal. The journal publish original research in English – conducted in or in relation to the Danish health-care system. When writing for the Danish Medical Journal please remember target audience which is the general reader. This means that the research area should be relevant to many readers and the paper should be presented in a way that most readers will understand the content. DMJ will publish the following articles: • Original articles • Protocol articles from large randomized clinical trials • Systematic reviews and meta-analyses • PhD theses from Danish faculties of health sciences • DMSc theses from Danish faculties of health sciences.