Anesthesiologists' Perspectives on GLP-1 Receptor Agonists in Elective Surgeries: A Qualitative Survey Analysis

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-9-2025

Abstract

Glucagon Like Peptide 1 Receptor Agonists (GLP-1 RAs) are a novel class of drugs that have recently gained popularity for their ability to effectively manage type 2 diabetes mellitus and promote weight loss by delaying gastric emptying. Because delayed gastric emptying increases the risk of pulmonary aspiration during anesthesia, standard preoperative fasting guidelines may be unsuitable for patients taking GLP-1 RAs. The American Society of Anesthesiologists published consensus-based guidance in 2023 for the preoperative management of patients taking GLP-1 RAs. Currently, the literature to support best practice is sparse. Therefore, the purpose of this study is to gather and analyze the perspectives of currently practicing anesthesiologists regarding their experiences providing care for patients taking GLP-1 RAs and their thoughts concerning the ASA's 2023 guidance.

This survey study was assigned exempt status by Michigan State University IRB. A focus group of six practicing anesthesiologists provided free-text statements describing their thoughts and experience with GLP-1 RAs, from which common themes and preferred professional language were identified and used to develop survey items. An iterative expert validation and cognitive pretesting process were used whereby the focus group provided feedback on draft survey items, items were edited, and the focus group re-reviewed the items repeatedly until all survey items were relevant and accurate. The final survey was hosted in Qualtrics software and the survey invitation link was sent to the electronic mailing list for author's (NCW) practice and to leadership contacts at 27 private and academic practices. These contacts were requested to forward the survey invitation to departments and colleagues elsewhere. The survey was available in June 2024 and remained open for responses for 11 weeks.

236 responses were recorded: 61 responses from author's (NCW) practice (response rate 51.6%) and 175 responses from national distribution. Most anesthesiologists were in their late career (31.5% had 21+ years of practice) and 66% see patients on a GLP-1 RA at least once a week. 48% of physicians rated their knowledge of GLP-1 RA's effect on surgical patients as "intermediate" with 43% rating themselves "Somewhat Strong" or "Strong". 32% of physicians had not read the ASA's 2023 guidance document. 67% of physicians agreed-strongly agreed that the document is effective at preserving patient safety. Most respondents see their patients correctly following (63%) the holding of their GLP-1 RAs "often" or "always". The most common symptoms that would lead physicians to cancel an elective case with an improperly held GLP-1 RA were vomiting, nausea, fullness, bloating, and an upset stomach. Most respondents commented on the 2023 guidance's lack of conclusive evidence and uncertainty of when to hold weekly GLP-1 doses.

This survey shows that most respondents perceive the ASA's 2023 guidance on GLP-1 RAs for elective surgeries as effective in preserving patient safety. Patients on a GLP-1 RA were frequently seen and were correctly holding the medications. Free text responses showed some confusion and highlighted the lack of clinical evidence in the ASA's 2023 guidance. This survey adds support to the ASA's 2023 guidance of GLP-1 RAs during elective cases; however, more data is needed to create evidence-based guidelines that are applicable to broad patient presentations and cases.

Comments

2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1672

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