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AAOS Now / Issue: June 2025 / research06

AAOS Now

Published 6/26/2025
Quality & Research AAOS Annual Meeting Knee

Stopping GLP-1 Agonists 14 Days before Total Joint Arthroplasty May Reduce Anesthesia Risks

Glucagon-like peptide-1 receptor agonists (GLP-1 agonists), such as semaglutide (e.g., Ozempic), have helped improve the management of type 2 diabetes and obesity. However, their use in the perioperative period surrounding major surgeries, such as total joint arthroplasty (TJA), remains an area of growing interest and concern.

A new study presented at the AAOS 2025 Annual Meeting examined how the timing of a patient’s last dose of Ozempic prior to total knee arthroplasty (TKA) or total hip arthroplasty (THA) influences anesthesia-related complications such as delayed emergence, aspiration, aspiration pneumonitis, and conversion to intubation. The study found that discontinuing semaglutide two weeks before surgery lowered a patient’s risk for these complications.

“GLP-1 agonists can delay gastric emptying and cause gastroparesis (paralysis of the stomach), leading to food remaining in the stomach and increasing anesthesia-related risks,” said lead author Christopher T. Holland, MD, MS, a TJA surgeon at Campbell Clinic Orthopaedics and faculty instructor at the University of Tennessee Health Science Center in Memphis. “Until this past year, there was a lack of any literature reporting on the perioperative risk profile for patients who take GLP-1 agonists before surgery and the impact on surgical outcomes. With a growing number of patients using these medications for diabetes or to meet certain optimization goals before undergoing hip and knee reconstructive surgery, our aim was to establish evidence-based guidelines on when to discontinue these to enhance patient safety and surgical success.”

Key findings
The study, “Optimal Timing for Cessation of GLP-1 Agonist before Elective Total Hip and Knee Arthroplasty,” obtained data from the TriNetX Research Network, a multi-institutional national aggregated database, to identify patients who underwent TKA or THA from Jan. 1, 2018, to Jan. 1, 2023. Patients who used GLP-1 agonists were categorized into cohorts based on when they discontinued use before surgery:

  • 30 days prior to surgery (n = 482)
  • 14 days prior to surgery (n = 591)
  • 7 days prior to surgery (n = 680)
  • 5 days prior to surgery (n = 758)
  • 3 days prior to surgery (n = 777)
  • 1 day prior to surgery (n = 706)
  • did not stop prior to surgery (n = 170)

The patients were compared with a control group of 206,005 patients with no history of GLP-1 agonist use.

The researchers analyzed the cohorts to determine the relationship between the time elapsed from the last GLP-1 agonist dose and complications from delayed emergence from anesthesia, aspiration event, aspiration pneumonitis, and conversion to intubation. Highlights of the findings include:

  • Stopping GLP-1 agonists 3 to 5 days prior to surgery was identified as an independent risk factor for delayed emergence from anesthesia. In contrast, the 7-day, 14-day, and 30-day cohorts had no independent risk factor for delayed emergence from anesthesia.
  • Stopping 3 to 7 days prior to surgery was an independent risk factor for aspiration, while the 14-day and 30-day cohorts had no independent risk factor for this complication.
  • Stopping 3 to 5 days before surgery was identified as an independent risk factor for aspiration pneumonitis, whereas the 7-day, 14-day, and 30-day cohorts had no independent risk factor for aspiration pneumonitis.
  • Stopping 3 to 7 days prior to surgery was an independent risk factor for conversion to intubation, whereas the 14-day and 30-day cohorts had no independent risk factor for this complication.
  • Patients who did not stop GLP-1 agonist use at any time prior to surgery were at the highest risk for all complications studied.

“This research provides additional evidence to suggest that discontinuing GLP-1 agonists at least 14 days before total joint replacement surgery is optimal to reduce the risk of delayed emergence from anesthesia, aspiration events, aspiration pneumonitis, and conversion to intubation,” said coauthor John R. Crockarell Jr, MD, MBA, FAAOS, a TJA surgeon at Campbell Clinic Orthopaedics and professor at the University of Tennessee Health Science Center. “This study offers a practical guideline for surgeons managing patients on GLP-1 agonists in the perioperative period for lower-extremity THA and TKA procedures. As orthopaedic surgeons, we must take a holistic approach to patient care, considering comorbidities and medications to optimize surgical outcomes. Understanding which medications can be safely continued or should be paused before surgery is key to providing comprehensive and effective care.”

Drs. Holland and Crockarell’s coauthors of “Optimal Timing for Cessation of GLP-1 Agonist before Elective Total Hip and Knee Arthroplasty” are James L. Guyton, MD, FAAOS; John R. Crockarell, MD, FAAOS; Marcus C. Ford, MD, FAAOS; Nuanqiu Hou, MS; Shivan N. Chokshi; and William M. Mihalko, MD, PhD, FAAOS.