The American Journal of Medicine · Oct 21, 2026

The Impact of Glucagon-Like Peptide-1 Receptor Agonists on Post-Anesthetic Pulmonary and Gastrointestinal Adverse Events: A Target Trial Emulation Using Multinational Database

By Chen SS, Lin TT, Chiang YL et al.

OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about perioperative aspiration and postoperative complications. This target trial emulation aims to evaluate the association between the use of GLP-1 RAs and the risk of postoperative pulmonary and gastrointestinal adverse events in patients undergoing general anesthesia. METHODS: Data was utilized from the TriNetX Global Collaborative Network. The study analyzed data from January 1, 2023, to December 31, 2023. Patients aged 20 years or older who underwent general anesthesia were included. These patients were divided into two groups: those using GLP-1 RA and those who were not. Propensity score matching was used to balance baseline characteristics. The primary outcome measures were the incidence of pulmonary and gastrointestinal adverse events within one-month post-anesthesia. Hazard ratios were calculated using Cox proportional hazards regression models to estimate the risk of these adverse events associated with GLP-1 RA use. RESULTS: A total of 21,948 patients were included after matching. Patients who used GLP-1 RAs demonstrated a significantly lower risk of pulmonary adverse events (HR 0.682 [0.496-0.938]). Secondary outcomes further revealed a reduction in the risk of postoperative respiratory failure, as well as postoperative hospitalization and emergency department revisits. However, there was a marginally increased risk of gastrointestinal adverse events in the GLP-1 RA group (HR, 1.034 [1.003-1.067]). CONCLUSIONS: The use of GLP-1 RAs prior to general anesthesia was not associated with higher risk of pulmonary adverse events. A slight elevation in gastrointestinal risks was observed, although the signal remained modest.

doi.org/10.1016/j.amjmed.2026.09.033PubMed 42906844Populations