AAOS

AAOS 2025: Stopping GLP-1 RAs two weeks before joint arthroplasty cuts anesthesia risks

March 14, 2025

Ceasing GLP-1 agonists 14 days before surgery is optimal to minimize risks of delayed emergence, aspiration, aspiration pneumonitis, and conversion to intubation. This finding underscores the importance of careful preoperative management of GLP-1 agonists in total joint arthroplasty patients to optimize surgical outcomes.

Study details: This retrospective analysis analyzed data from 206,005 patients who underwent total hip or knee arthroplasty between 2018 and 2023. Patients who ceased Ozempic at various intervals before surgery (30, 14, 7, 5, 3, and 1 day) were compared with those who continued its use through surgery. Propensity-matched cohorts were used to evaluate the impact on anesthesia complications, including delayed emergence, aspiration, aspiration pneumonitis, and conversion to intubation.

Results: Stopping Ozempic five days before surgery was an independent risk factor for delayed emergence from anesthesia (OR, 1.59), with higher risks for stopping three days and one day prior (OR, 1.84 and 2.23, respectively). Aspiration risk increased when stopping seven days before surgery (OR, 1.24) and was even higher for stopping five days, three days, and one day prior (OR, 2.53, 3.09, and 4.96, respectively). Stopping seven days before surgery also raised the risk for aspiration pneumonitis (OR, 1.29), with greater risks for stopping five days (OR, 2.74) and one day prior (OR, 2.74). Stopping Ozempic seven days before surgery as an independent risk factor for conversion to intubation (OR, 1.39), with even higher risks noted for stopping five days (OR, 2.09), three days (OR 4.68), and one day prior (OR, 6.37). Patients who continued Ozempic use through surgery faced the highest risk for all complications.

Sources:

(2025, March 10). American Academy of Orthopaedic Surgeons. New Study Recommends Stopping GLP-1 Agonists 14 Days Before Total Joint Arthroplasty to Reduce Anesthesia Risks. [News release]. https://aaos-annualmeeting-presskit.org/2025/research-news/new-study-recommends-stopping-glp-1-agonists-14-days-before-total-joint-arthroplasty-to-reduce-anesthesia-risks/

Chokshi, SN, et al. “Optimal timing for cessation of GLP-1 agonist before elective total hip and knee arthroplasty.” AAOS 2025; Abstract https://submissions.mirasmart.com/Verify/AAOS2025/Submission/out/AAOS2025-005503.PDF