GLP-1 receptor agonist-induced post-procedural gastrointestinal and biliary complications in cardiothoracic surgery
Z Wright, J M Mishkin, B L Lenoir, K R Rajkumar, A S Seals, P B Behr, B I Imielski, Y B Barac, O G GilbertAbstract
Background/Introduction
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are endogenous hormone analogues used for a variety of conditions, including type 2 diabetes mellitus, obesity, and obstructive sleep apnea. Gastrointestinal (GI) and biliary complications with these medications are well established. Implications for peri-procedural management have been challenging, reflected by evolving pre-procedural recommendations. Perioperative outcomes in a cardiothoracic surgery population have not been established, especially with urgent and emergent cases.
Purpose
The aim of this study is to examine the incidence of GI and biliary post-procedural complications in patients undergoing coronary artery bypass grafting (CABG) and/or surgical valve intervention who did not withhold their GLP-1 RA prior to surgery.
Methods
We conducted a single institution, retrospective study including patients who underwent CABG and/or surgical valve intervention between December 2016 and June 2025. GLP-1 RA was identified using the surgical encounter admission medication list. Patients with a GLP-1 RA who had a preadmission test visit before admission were categorized within the GLP-1 RA held on admission category, and those who did not have a visit were categorized as GLP-1 RA not held on admission category. Group differences were assessed using analysis of variance (continuous) and Chi-square/fisher test (categorical). Primary outcomes included biliary disease, gastroparesis, paralytic ileus, ileus distinct from bowel obstruction, GI ischemia, GI hemorrhage, GI perforation, or pneumatosis intestinalis. Secondary outcomes included gastroenterology or general surgery consult within 30 days of procedure, 30-day mortality, in-hospital mortality, 30-day readmission, and length of stay.
Results
In our retrospective study, 6,205 patients with CABG and/or surgical valve intervention were included (71.6% male, 28.4% female; mean age on admission 63.4 ± 13.1). Of those, 82 patients (1.45%) were on a GLP-1 RA, with 9 patients (9.8%) holding the medication prior to admission for surgery, and 73 patients (89%) not holding the medication prior to admission for surgery (Table 1). A total of 6,123 patients (98.7%) were included who were not prescribed a GLP-1 RA. In comparison to patients who held GLP-1 RA before presentation versus those who did not and versus those not on GLP-1 RA therapy, there was no statistically significant difference among the primary GI, biliary, or secondary outcomes (Table 2).
Conclusion
Among patients undergoing urgent CABG and/or surgical valve intervention without the ability to hold GLP-1 RA therapy prior to presentation, there was no difference in GI outcomes or clinical outcomes of 30-day mortality, 30-day readmissions, or length of stay when compared to those who held the medication prior to their admission or those not on the medication, suggesting reassurance when GLP-1 RA is not able to be held under urgent circumstances.Table 1For image description, please refer to the figure legend and surrounding text.Table 2For image description, please refer to the figure legend and surrounding text.