In 3,196 propensity-matched spine surgery patients, GLP-1 receptor agonist users had lower rates of blood clots, kidney injury, and extended hospital stays after cervical fusion — with no increased aspiration risk despite the drugs' known effect on gastric emptying.
No aspiration increase: 0.81% vs 1.25% (P=0.39)Despite concerns about delayed gastric emptying, GLP-1 drug users had numerically fewer (not more) pulmonary aspiration events after cervical spine surgery, while also experiencing fewer blood clots and kidney injuries
What the researchers found
Among 1,598 propensity-matched pairs (3,196 total patients), GLP-1 agonist users showed:
No increased aspiration risk: 0.81% vs 1.25% (P=0.39, not significant).
Reduced 90-day complications: DVT/PE 0.44% vs 0.94% (P=0.04); acute kidney injury 0.94% vs 1.69% (P=0.04); extended hospital stays (≥3 days) 15.96% vs 18.65% (P=0.04).
No differences at 1 year: DVT/PE 1.56% vs 2.00% (P=0.36); pseudoarthrosis/nonunion 2.82% vs 3.25% (P=0.50).
Importantly, GLP-1 drugs did not impair bone fusion (pseudoarthrosis rates were equivalent), addressing another theoretical concern about these medications in spine surgery.
Why it matters
With millions of people now taking GLP-1 drugs, anesthesiologists and surgeons have been increasingly concerned about perioperative aspiration risk from delayed gastric emptying. Some guidelines recommend stopping GLP-1 drugs days before surgery or requiring additional fasting. This large study provides reassuring evidence that these drugs don't increase aspiration risk in anterior cervical surgery — and actually reduce other postoperative complications. For the estimated 500,000+ ACDF procedures performed annually, this has direct implications for perioperative medication management.
How the study worked
Retrospective propensity-matched cohort study using an administrative claims database. 20,941 patients with T2DM and/or obesity undergoing single or two-level primary ACDF between 2015-2022 were identified. GLP-1 agonist users (within 6 months before and after surgery) were matched 1:1 with non-users on age, sex, comorbidity index, insulin dependence, diabetic complications, other diabetes medications, morbid obesity, and smoking status. Multivariable logistic regressions examined 90-day and 1-year outcomes.
What this study cannot tell us
Retrospective administrative database study — cannot establish causation. The database may not capture all instances of aspiration (mild cases may go undiagnosed). GLP-1 agonist adherence was assumed from prescription claims, not verified. Specific GLP-1 agents and doses were not differentiated. The timing of the last GLP-1 dose relative to surgery was unknown. The study period (2015-2022) includes years when GLP-1 use was less common, potentially limiting statistical power for rare events. Single surgical procedure type limits generalizability.
How to read the evidence
Large retrospective propensity-matched cohort study with over 3,000 patients. The propensity matching on extensive covariates strengthens the evidence, though the retrospective design and administrative database limitations prevent establishing causation. The sample size provides good power for the complications studied.
When this study was published
Published in 2025, this is a very timely study addressing one of the most pressing perioperative questions as GLP-1 drug prescriptions continue to surge.
The bigger picture
The perioperative management of GLP-1 drugs is one of the most actively debated topics in anesthesiology. The American Society of Anesthesiologists released guidelines in 2023 suggesting holding GLP-1 drugs before surgery due to aspiration concerns, but evidence has been largely anecdotal. This study adds to the growing body of evidence — alongside similar studies in orthopedic and general surgery — that GLP-1 drugs are safe perioperatively and may actually improve outcomes through anti-inflammatory, metabolic, and glycemic benefits. The finding could influence future perioperative guidelines.
Questions still open
- Should current guidelines recommending GLP-1 drug cessation before surgery be revised based on this and similar accumulating evidence?
- What is the mechanism behind the reduced DVT/PE and kidney injury rates — anti-inflammatory effects, better glycemic control, or weight-related factors?
- Do the perioperative benefits of GLP-1 drugs extend to higher-risk surgical procedures where aspiration risk is more significant?
Common questions
Should I stop taking my GLP-1 drug before surgery?
Why were there fewer blood clots and kidney injuries in GLP-1 users?
Read the original research
Glucagon-like peptide-1 receptor agonist use and perioperative outcomes after anterior cervical discectomy and fusion: a propensity-matched cohort study.
The spine journal : official journal of the North American Spine Society
Citation
Heo, Kevin Y; Barchick, Stephen R; Sowa, Aubrie M; Chao, Myra; Rajan, Prashant V; Goh, Brian C; Yoon, Sangwook T. (2025). Glucagon-like peptide-1 receptor agonist use and perioperative outcomes after anterior cervical discectomy and fusion: a propensity-matched cohort study.. The spine journal : official journal of the North American Spine Society. https://doi.org/10.1016/j.spinee.2025.12.019