Considerations for Perioperative Management Guidance Regarding GLP-1 Receptor Agonists: Evaluation of Current Practices and Future Directions

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have become increasingly prevalent and have the potential to delay gastric emptying. The American Society of Anesthesiologists (ASA) released guidance regarding the perioperative management of patients receiving GLP-1 RAs, but it is unclear the extent to which hospitals in the U.S. Military Health System have implemented policies consistent with this guidance. Methods: A questionnaire was sent to active duty anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) working in the U.S. Military Health System. The questions assessed the presence of institutional GLP-1 RA perioperative policies, adherence to the policy (if applicable), the basis and components of current and recommended future institutional policies, institutional tracking of policy implementation and outcomes, and knowledge, skills, barriers, and continuing medical education goals related to the perioperative management of patients receiving GLP-1 RAs. Results: The response rate was 32% (N = 265); a little over half of the respondents were anesthesiologists (53%); and respondents’ primary practices included over 50 institutions. More than half (54%) indicated that their primary practice location had a GLP-1 RA perioperative policy; 65% of whom indicated that they always followed the policy. In review of practice locations with >1 respondents, there was a lack of perfect agreement across most locations. The most commonly reported basis for the policy was ASA guidance (87%), followed by department leadership (37%). Barriers to any system-wide GLP-1 perioperative management policy included a lack of gastric ultrasound practice and comfort, as well as reported skills and knowledge, pressure not to cancel cases, scheduling problems, and productivity requirements. Conclusions: Formal policies were reported by most respondents, but inconsistencies within practice locations suggest that local policy implementation could be improved. Commonly reported barriers to future system-wide policy implementation provide data-driven information for system-wide efforts to improve policy success.