Glucagon-like peptide-1 receptor agonists (GLP-1A) have advanced the treatment of type 2 diabetes and obesity. Given the prevalence of these conditions among candidates for total joint arthroplasty (TJA), managing GLP-1A in the perioperative period is crucial to minimize complications.
The TriNetX Research Network was queried for patients who underwent total hip or knee arthroplasty from January 2018 to January 2023. A control group of 206,005 patients with no prior Ozempic use was identified. Ozempic users were categorized based on when they stopped the medication before surgery: 30 days (482 patients), 14 days (591), 7 days (680), 5 days (758), 3 days (777), 1 day (706), and continued use through surgery (170). Propensity-matched cohorts were analyzed to determine the relationship between the time of last Ozempic dose and anesthesia complications using multivariate logistic regression.
Results
Stopping Ozempic 5 days before surgery was an independent risk factor for delayed emergence from anesthesia (OR 1.59, P=0.005); stopping 3 days (OR 1.84, P <0.001) and 1 day prior (OR 2.23, P < 0.001) also increased this risk.
For aspiration, stopping 7 days prior was a risk factor (OR 1.24, P =0.002), with higher risks for stopping 5 days (OR 2.53, P <0.001), 3 days (OR 3.09, P <0.001), and 1 day (OR 4.96, P <0.001) prior.
Stopping 7 days before surgery also increased the risk for aspiration pneumonitis (OR 1.29, P <0.001), with even higher risks for stopping 5 days (OR 2.74, P <0.001) and 1 day prior (OR 2.74, P <0.001).
Multivariate logistic regression identified last Ozempic dose at 7 days prior to surgery as an independent risk factor for conversion to intubation (OR 1.39 [95% CI 1.06-1.56], P =0.0343). Similarly, last Ozempic dose at 5 days (OR 2.09, [95% CI 1.76-2.36], P <0.001), 3 days (OR 4.68, [95% CI 4.40-4.97], P <0.001), and 1 day (OR 6.37, [95% CI 5.92-6.72], P <0.001) were independent risk factors for conversion to intubation.
The highest risk for all complications was observed in patients who continued Ozempic use through surgery.
Diabetes itself was not an independent risk factor for any of the complications.
Discussions and Conclusions
Stopping Ozempic more than 7 days prior to surgery reduced the risk of delayed emergence from anesthesia and aspiration pneumonitis, additionally stopping 14 days prior to surgery reduced the risk of aspiration and conversion to intubation in this cohort. To minimize risks of delayed emergence from anesthesia, aspiration, aspiration pneumonitis, and conversion to intubation, ceasing GLP-1A 14 days before surgery is optimal. Careful planning and coordination in managing GLP-1A in the preoperative period are essential to optimize surgical outcomes.
Chokshi SN, Hou N, Ford MC, Crockarell JR, Mihalko JL, Holland CT. Optimal Timing for Cessation of GLP-1 Agonist Before Elective Total Hip and Knee Arthroplasty. Presented at 2025 Annual Meeting of the American Academy of Orthopaedic Surgeons. San Diego, CA: March 10-14, 2025.
