GLP-1 Receptor Agonists in Orthopaedic Surgery: Implications for Perioperative Care and Outcomes
Rahul Ramanathan, Joon Y. Lee, Jonathan Dalton, Ryan Lin, Isaac Lee, Christopher Gonzalez, Jeremy D. Shaw, Gregory D. Schroeder, Christopher K. Kepler, Michael J. Spitnale, Alexander R. Vaccaro, Alexandra S. Gabrielli, Richard A. Wawrose
Abstract
➢ Glucagon-like peptide-1 (GLP-1) receptor agonists are a promising tool for preoperative weight loss in the patient who is undergoing orthopaedic surgery and has concomitant obesity and type-2 diabetes mellitus.➢ With regard to the perioperative management of GLP-1 receptor agonists for the orthopaedic surgeon, the American Society of Anesthesiologists (ASA) recommends withholding daily-dose GLP-1 therapy on the day of the elective surgical procedure and withholding weekly-dose therapy for the week prior to the procedure.➢ The ASA recommends postponing surgery or proceeding with "full stomach precautions" if the patient undergoing an orthopaedic procedure and taking GLP-1 therapy exhibits gastrointestinal symptoms on the day of the elective procedure.➢ In the trauma setting, patients taking GLP-1 therapy should proceed with the surgical procedure at the discretion of the surgeon with full stomach precautions or a preoperative point-of-care gastric ultrasound.➢ GLP-1 receptor agonists show the potential for disease modification in osteoarthritis and osteoporosis.