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Medicamentos GLP-1 (Ozempic, Wegovy) y su cirugía

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If you take a GLP-1 medication (such as semaglutide — Ozempic or Wegovy) and you are having an operation: what these drugs do, why they matter for your anaesthetic (delayed stomach emptying and aspiration risk), and what you should do before surgery.

Updated Sep 2026
Una pluma inyectora médica.
Los medicamentos GLP-1 son cada vez más habituales y tienen implicaciones que merecen ser analizadas antes de la cirugía y la anestesia. Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

¿Qué es este medicamento?

Los medicamentos GLP-1 constituyen un grupo de fármacos que quizás conozca por sus nombres comerciales, como Ozempic o Wegovy. Su denominación médica es “agonistas de los receptores GLP-1”, lo que significa que imitan la acción de una hormona natural presente en el cuerpo. Las personas los toman por dos motivos principales: para controlar la diabetes tipo 2 y para perder peso.

En el organismo, estos medicamentos actúan de dos maneras: reducen el apetito, por lo que siente menos ganas de comer; además, ralentizan el vaciado gástrico, de modo que los alimentos permanecen más tiempo en el estómago y usted se siente saciado antes. Por eso la pérdida de peso es un efecto frecuente.

Si toma alguno de estos medicamentos y tiene prevista una cirugía, esto es relevante para su equipo quirúrgico. Dado que su uso es cada vez más común, los cirujanos atienden a más pacientes que los toman en el período previo a la operación [1]. Uno de los motivos por los que son importantes es su efecto sobre el estómago: al vaciarse más lentamente, el equipo de anestesia debe conocer este dato al planificar su tratamiento [2].

La investigación sobre estos medicamentos y la cirugía de reemplazo articular sigue en desarrollo. Algunos estudios sugieren posibles beneficios, como una menor probabilidad de infección tras un reemplazo de cadera o rodilla [3]; sin embargo, otros resultados son contradictorios y se requiere más investigación [4]. Aún no se ha llegado a una conclusión definitiva.

No es necesario que interrumpa el tratamiento por su cuenta antes de la cirugía. Las recomendaciones actuales indican que no se aconseja suspender estos medicamentos antes de una intervención, ya que podría afectar el control de su glucosa en sangre y su peso [5]. Su equipo médico conversará con usted sobre el plan específico a seguir.

Cómo afecta esto a su cirugía y anestesia

Lo más importante que debe saber es respecto a su estómago. Estos medicamentos ralentizan la velocidad con la que el estómago vacía su contenido. Esto significa que los alimentos pueden permanecer allí más tiempo de lo esperado, incluso después de haber ayunado. Si se le administra sedación durante la operación, el contenido estomacal podría retroceder y entrar en los pulmones; esto se conoce como aspiración. Es un riesgo conocido con cualquier tipo de anestesia, y estos medicamentos pueden incrementarlo.

El equipo anestésico gestiona esta situación con gran cuidado. Siguen pautas que indican suspender el uso de estos medicamentos alrededor del momento de la operación y recomiendan un ayuno más prolongado de lo habitual. Algunos equipos también realizan una ecografía del estómago antes del procedimiento para comprobar si aún hay alimentos o líquido en su interior. Los estudios han demostrado que la mayoría de las personas que toman estos medicamentos conservan cierta cantidad de alimentos o líquido en el estómago, incluso tras un ayuno normal [1]. No obstante, no está tan claro si esto realmente provoca que alimentos o líquido lleguen a los pulmones; la investigación al respecto resulta contradictoria [1].

También hay noticias alentadoras respecto a la recuperación. Estudios realizados en pacientes sometidos a prótesis de cadera o rodilla indican que quienes tomaron estos medicamentos en el periodo previo a la cirugía no presentaron un aumento significativo en la necesidad de intervenciones quirúrgicas adicionales a corto plazo [2]. Algunos estudios incluso señalan un menor riesgo de infecciones después de la operación [2]. En el caso de cirugías de mano, como la liberación del túnel carpiano, un estudio observó una ligera reducción en los problemas de cicatrización y ningún incremento en otras complicaciones durante los primeros 90 días [3].

Su equipo médico trabajará conjuntamente con usted para planificar todo esto: su cirujano, el anestesista y, si es necesario, el médico encargado de controlar su diabetes. El objetivo es diseñar un plan personalizado que garantice la seguridad en cuanto a su medicación, las instrucciones de ayuno y la propia operación. Los investigadores siguen estudiando cuál es la mejor forma de atender a pacientes que toman estos medicamentos antes de una cirugía [4]; por ello, su equipo se mantendrá al día y le explicará detalladamente qué debe hacer antes de la operación.

Qué debe hacer

Si toma un medicamento de tipo GLP-1 y tiene programada una cirugía, informe a todos los profesionales que participan en su atención: su cirujano, el anestesista y su médico de cabecera. También es útil informar al médico que le recetó el medicamento, ya que es quien gestiona su plan de tratamiento para la diabetes o el control de peso y participará en la toma de decisiones.

No interrumpa el tratamiento por su cuenta. Si cree que sería necesario suspenderlo temporalmente, consulte primero con el médico que lo recetó. Dejar de tomarlo sin orientación puede afectar sus niveles de azúcar en sangre y su peso.

Su equipo médico le dará instrucciones claras antes de la operación. Estas podrían indicar si es preciso suspender el medicamento y por cuánto tiempo. También incluirán indicaciones sobre el ayuno, que podría ser más prolongado de lo habitual, ya que estos fármacos ralentizan el vaciado gástrico. Siga dichas instrucciones al pie de la letra.

Su atención se planifica de forma conjunta. Dado que estos medicamentos influyen en el vaciado gástrico, el cirujano y el anestesista colaboran con el médico especialista en diabetes para diseñar un plan adaptado a usted [1]. Los investigadores siguen estudiando cuál es la mejor forma de atender a pacientes que toman estos fármacos antes de una cirugía [2], por lo que su equipo se mantendrá al día al respecto.

Si algo no le queda claro, no dude en preguntar. No hay pregunta sobre su medicación que sea insignificante cuando se trata de una operación.

Referencias

[1] El impacto de los agonistas del péptido similar al glucagón-1 en la artroplastia de cadera y rodilla, así como consideraciones perioperatorias. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.002

[2] Retraso en el vaciamiento gástrico inducido por los agonistas de los receptores del péptido similar al glucagón-1 y sus implicaciones para el riesgo perioperatorio durante la anestesia. The Korean Journal of Internal Medicine. 2026. DOI: 10.3904/kjim.2025.277

[3] Agonistas de los receptores del péptido similar al glucagón-1 en la artroplastia total: una revisión sistemática exhaustiva para que los cirujanos ortopédicos conozcan. Arthroplasty. 2026. DOI: 10.1186/s42836-026-00375-w

[4] Impacto de los agonistas de los receptores del péptido similar al glucagón-1 en los resultados postoperatorios tras la artroplastia: una revisión sistemática. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.07.015

[5] Uso perioperatorio de los agonistas de los receptores GLP-1: recomendaciones de práctica clínica de ANZCA. ANZCA. 2025.

[6] Manejo anestésico perioperatorio de los agonistas de los receptores GLP-1: una revisión sistemática de los posibles riesgos. Perioperative Medicine. 2026. DOI: 10.1186/s13741-026-00662-9

[7] Impacto de los agonistas de los receptores del péptido similar al glucagón-1 en el período perioperatorio sobre los resultados postoperatorios tras la liberación del túnel carpiano. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100746

[8] Agonistas de GLP-1: una nueva esperanza para los pacientes, un nuevo desafío para los anestesiólogos. Anaesthesiology Intensive Therapy. 2025. DOI: 10.5114/ait/203167

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Glucagon-like peptide-1 receptor agonists induce delayed gastric emptying [1].
  • The pharmacological mechanisms of GLP-1 RA-induced delayed gastric emptying have clinical implications for perioperative aspiration risk during anesthesia [1].
  • Interdisciplinary collaboration between endocrinologists and anesthesiologists is emphasized for safe and individualized perioperative management of patients on GLP-1 RAs [1].
  • GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight [2].
  • Further high-quality studies are called for to address the optimal perioperative care of patients on GLP-1RAs due to their increasing popularity in patients with obesity [3].
  • Conflicting findings in the literature highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes [4].
  • Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists [5].
  • It is important for arthroplasty surgeons to understand the implications of GLP-1 agonist use in the perioperative period [5].
  • GLP-1 agonist use should not be a contraindication for proceeding with total shoulder arthroplasty based on data showing no association with adverse events following shoulder surgery [6].
  • Elective preprocedural cessation of GLP-1RAs and GLP-1/GIPRAs is not recommended due to insufficient data supporting cessation and risks of hyperglycaemia and compromised weight control [7].
  • The variability in available studies, potential confounding factors, and severe heterogeneity of conclusions emphasize the need for more high-quality evidence-based primary research to optimize perioperative management of patients taking GLP-1 RAs [8].
  • GLP-1 agonists have effects on bone health that are relevant to perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery [9].
  • GLP-1RA use suggests a potential benefit for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty [10].

Effects on Surgery and Recovery

Perioperative Anesthesia and Gastric Emptying

  • Authors call for further high-quality studies to address the optimal perioperative care of patients on GLP-1RAs due to their increasing popularity in patients with obesity [3].
  • Available observational evidence suggests that extended GLP-1 RA withholding, 24-hour clear liquid diets, and pre-procedural gastric POCUS may be associated with reduced residual gastric content in selected patient populations [14].

Arthroplasty Outcomes

  • Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists, making it important to understand the implications of their use in the perioperative period [5].
  • Conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes in arthroplasty [4].
  • Findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty [10].
  • While GLP-1 receptor agonists show potential to reduce postoperative complications in total joint arthroplasty, findings remain inconsistent, and further research is needed to clarify their impact on outcomes and establish perioperative management guidelines [11].
  • Preoperative glucagon-like peptide-1 receptor agonist use may be linked to reduced readmission risk following joint arthroplasty, without evidence of increased postoperative medical harm [12].
  • Semaglutide and other GLP-1 agonists may increase the number of eligible candidates for elective total joint arthroplasty by enabling weight loss and improving diabetic control [13].
  • Semaglutide and other GLP-1 agonists may potentially reduce postoperative complications such as sepsis and prosthetic joint infections [13].
  • Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty is not associated with a consistent increase in short-term revision rates [16].
  • Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty may be associated with a reduced risk of postoperative infection [16].

Other Orthopedic Procedures

  • Based on data from a systematic review and meta-analysis, GLP-1 agonist use should not be a contraindication for proceeding with total shoulder arthroplasty [6].
  • Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following carpal tunnel release [15].
  • Perioperative GLP-1RA use did not increase the odds of any other 90-day postoperative complications following carpal tunnel release [15].

Bone Health

  • A narrative review explores the mechanisms of action of GLP-1 agonists, their effects on bone health, and the implications of their use in perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery [9].
  • Exenatide is the best option agent with regard to the risk of fracture [17].

Practical Considerations

Perioperative Anesthesia and Gastric Emptying

  • Delayed gastric emptying induced by GLP-1 RAs has implications for perioperative aspiration risk during anesthesia [1].

Medication Management

Arthroplasty Outcomes and Eligibility

  • Conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes [4].

Shoulder Surgery

Bone Health and Spine Surgery

Key Evidence

  • [L4] This review summarizes the pharmacological mechanisms and clinical implications of GLP-1 RA-induced delayed gastric emptying, evaluates current literature on perioperative aspiration risk, and emphasizes the importance of interdisciplinary collaboration between endocrinologists and anesthesiologists to ensure safe and individualized perioperative management. [1] (10.3904/kjim.2025.277)
  • [Paper] While efficacious, GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight. [2] (10.2106/jbjs.rvw.23.00167)
  • [L4] Due to the increasing popularity of GLP-1RAs in patients with obesity, the authors call for further high-quality studies to address the optimal perioperative care of patients on GLP-1RAs. [3] (10.5114/ait/203167)
  • [L4] However, conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes. [4] (10.1016/j.arth.2025.07.015)
  • [L5] Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists, making it important to understand the implications of their use in the perioperative period. [5] (10.1016/j.arth.2023.12.002)
  • [L1] Based on this data, GLP-1 agonist use should not be a contraindication for proceeding with TSA. [6] (10.1016/j.jse.2025.12.005)
  • [L2] The variability in available studies, potential confounding factors, and the severe heterogeneity of conclusions all emphasize the need for more high-quality evidence-based primary research to optimize perioperative management of patients taking GLP-1 RAs. [8] (10.1186/s13741-026-00662-9)
  • [L4] This narrative review explores the mechanisms of action of GLP-1 agonists, their effects on bone health, and the implications of their use in perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery. [9] (10.1177/15563316261438492)
  • [L1] These findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty. [10] (10.1016/j.arth.2025.09.054)
  • [L5] The paper concludes that while GLP-1 receptor agonists show potential to reduce postoperative complications in total joint arthroplasty, findings remain inconsistent, and further research is needed to clarify their impact on outcomes and establish perioperative management guidelines. [11] (10.1016/j.arth.2025.10.027)
  • [L1] Preoperative glucagon-like peptide-1 receptor agonist use may be linked to reduced readmission risk following joint arthroplasty, without evidence of increased postoperative medical harm. [12] (10.1016/j.arth.2025.11.036)
  • [L5] Semaglutide and other GLP-1 agonists may increase the number of eligible candidates for elective total joint arthroplasty by enabling weight loss and improving diabetic control, while also potentially reducing postoperative complications such as sepsis and prosthetic joint infections. [13] (10.1016/j.arth.2023.12.014)
  • [L4] Available observational evidence suggests that extended GLP-1 RA withholding, 24-hour clear liquid diets, and pre-procedural gastric POCUS may be associated with reduced residual gastric content in selected patient populations. [14] (10.7759/cureus.108216)
  • [L3] Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following CTR and did not increase the odds of any other 90-day postoperative complications. [15] (10.1016/j.jhsg.2025.100746)
  • [L4] Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty is not associated with a consistent increase in short-term revision rates and may be associated with a reduced risk of postoperative infection. [16] (10.1186/s42836-026-00375-w)
  • [L1] Exenatide is the best option agent with regard to the risk of fracture. [17] (10.1007/s00198-018-4649-8)

References

[1] Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia. The Korean Journal of Internal Medicine. 2026. DOI: 10.3904/kjim.2025.277

[2] Glucagon-like Peptide-1 Agonists. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.23.00167

[3] GLP-1 agonists: a new hope for patients, a new challenge for anaesthetists. Anaesthesiology Intensive Therapy. 2025. DOI: 10.5114/ait/203167

[4] Impact of Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes in Arthroplasty: A Systematic Review. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.07.015

[5] The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.002

[6] GLP-1 receptor agonist therapy is not associated with adverse events following shoulder surgery: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.12.005

[7] Periprocedural use of GLP-1 receptor agonists: ANZCA Clinical Practice Recommendations. ANZCA. 2025.

[8] Perioperative anesthesia management of GLP-1 receptor agonists: a systematic review of potential risks. Perioperative Medicine. 2026. DOI: 10.1186/s13741-026-00662-9

[9] GLP-1 Agonists in Orthopedic Surgery: A Narrative Review of Bone Health and Surgical Implications. HSS Journal. 2026. DOI: 10.1177/15563316261438492

[10] The Impact of Glucagon-Like Peptide-1 Receptor Agonist Use on Clinical Outcomes After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of 346,899 Patients. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.09.054

[11] Glucagon-Like Peptide-1 Receptor Agonists: Have We Found the Holy Grail for Total Joint Arthroplasty?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.10.027

[12] Glucagon-Like Peptide-1 Receptor Agonists, Readmission, and Postoperative Complications in Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.11.036

[13] Semaglutide and Other GLP-1 Agonists: A Boon for the Arthroplasty Industry?. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.014

[14] Peri-Procedural Fasting and Gastric Ultrasound Strategies in Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist Users: A Systematic Review With Qualitative Synthesis. Cureus. 2026. DOI: 10.7759/cureus.108216

[15] Impact of Perioperative Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes Following Carpal Tunnel Release. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100746

[16] Glucagon-like peptide-1 receptor agonists in total joint arthroplasty: a comprehensive systematic review of what orthopaedic surgeons should know. Arthroplasty. 2026. DOI: 10.1186/s42836-026-00375-w

[17] Glucagon-like peptide-1 receptor agonists and fracture risk: a network meta-analysis of randomized clinical trials. Osteoporosis International. 2018. DOI: 10.1007/s00198-018-4649-8

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3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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