The landscape of perioperative care for patients taking GLP-1 receptor agonists (GLP-1 RAs) has shifted significantly with the release of new multi-society guidance in October 2024, marking a substantial change from previous recommendations regarding these increasingly popular medications.
The updated clinical guidance, developed through collaboration between the American Society of Anesthesiologists (ASA), American Society for Metabolic and Bariatric Surgery, American Gastroenterological Association, and other leading medical societies, now suggests that most patients can safely continue GLP-1 RA therapy prior to elective surgery and gastrointestinal endoscopic procedures.
Evolution of GLP-1 RA Perioperative Guidelines
In 2023, initial ASA guidance recommended holding GLP-1 RAs before procedures due to concerns about delayed gastric emptying and aspiration risks. "Although the incidence [of aspiration] may be relatively low, the consequences are significant," explained Dr. Girish Joshi, professor of anesthesiology at UT Southwestern Medical School and author of the 2023 guidance.
The impact of these initial recommendations was substantial. "Patients were canceled for procedures if they didn't hold the GLP-1 RA, depending on the institution," noted Dr. Violeta Popov, Director of Bariatric Endoscopy at VA NY Harbor Healthcare System.
Key Changes in 2024 Guidance
The new guidance emphasizes individualized risk assessment and shared decision-making between patients and their healthcare teams. This approach considers:
- Patient-specific risk factors
- Metabolic needs for continuing GLP-1 RA therapy
- Type and timing of the planned procedure
- Individual patient preferences
"We tried to seek a middle ground where one of the focuses is on a multidisciplinary approach that includes shared decision-making with the patient," explained Dr. Andrew Wang, chief of gastroenterology at the University of Virginia and lead author of the new guidance.
Clinical Impact and Implementation
Healthcare providers are already adapting their practices to align with the updated recommendations. Dr. Adelina Hung, Clinical Assistant Professor at Rosalind Franklin University, describes her approach: "I inform my patients about the potential concerns as well as the inconclusive/lack of data currently available so that we can come to a joint decision based on their individual risk factors and preferences."
Growing Importance of GLP-1 RA Management
The timing of this guidance is crucial given the exponential growth in GLP-1 RA use. Recent analysis shows approximately 137 million US adults are candidates for semaglutide based on current indications, which include:
- Type 2 diabetes management
- Cardiovascular risk reduction
- Chronic weight management
- Obesity with cardiovascular disease
Future Considerations
While the new guidance represents a significant step forward, experts acknowledge the limitations of current evidence. "We are still working with low-quality evidence and a small number of studies," Dr. Joshi cautioned. As new GLP-1 RAs with different potencies and side effects enter the market, continued research will be essential to refine these recommendations further.
"The more we learn about this, the better," concluded Dr. Wang, emphasizing the need to balance long-term patient care with procedural safety. This evolving guidance reflects the medical community's commitment to evidence-based practice while maintaining patient safety and optimal clinical outcomes.
