844-P: Association between Preoperative GLP-1RA Use and Postoperative Respiratory Complications in Real-World Patients Undergoing Elective Surgical Procedures—A Target Trial Emulation Study

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Introduction and Objective: There have been growing concerns about GLP-1 RA use and the risk of aspiration pneumonia. Mixed results exist regarding aspiration pneumonia risk with perioperative GLP-1 RA use, with limited focus on elective surgical procedures. Therefore, we assessed the association between preoperative GLP-1 RA use and postoperative respiratory complications in patients undergoing elective surgical procedures.Methods: This retrospective cohort study followed the target trial emulation framework and used OneFlorida+ EHR data from Jan 1, 2015, to Jan 31, 2023. Patients undergoing elective surgical procedures were included, excluding emergency/trauma, transplant, neurosurgery, gastric, head and neck surgeries, and/or pregnancy. GLP-1 RA users were defined as those using GLP-1 RAs within a week before surgery, compared to non-users. The primary outcome was postoperative respiratory complications within 7 days, defined as a composite of aspiration pneumonia and respiratory failure. Subgroups included sex, age, race/ethnicity, T2D, obesity, GLP-1 RA type, and duration. Sensitivity analysis followed patients until discharge. Hazard Ratios with 95% CIs were estimated using Cox models in a matched cohort.Results: After propensity matching, 655 GLP-1 RA users and 1855 non-users were included. GLP-1 RA use was associated with increased postoperative respiratory complications (HR: 1.61, 95% CI: 1.08-2.39); 5.5% users vs. 3.5% non-users. The risk remained consistent in sensitivity analysis. Subgroup analysis showed higher risks in adults ≥50 years, patients with T2D, Hispanics, and, particularly, lixisenatide-exenatide users (HR: 2.97, 95% CI: 1.13-7.77), there was no difference in risk by GLP-1 RA duration of action.Conclusion: Preoperative GLP-1 RA use was associated with increased postoperative respiratory complications compared to non-users.

Disclosure

P. Kotecha: Employee; Takeda Pharmaceutical Company. W.T. Donahoo: None. A. Sharma: None. R.C. Sun: None. C. Yang: None. J. Bian: None. J. Guo: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)



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