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GLP-1 Medications (Ozempic, Wegovy) and Your Surgery

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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 20268 citations
A medical injection pen.
GLP-1 medications are increasingly common and have implications worth discussing before surgery and anaesthesia. Kieran Hirpara 4.0

What this medication is

GLP-1 medications are a group of medicines you may know by brand names such as Ozempic or Wegovy. Their medical name is GLP-1 receptor agonists, which means they copy a natural hormone in your body. People take them for two main reasons: to manage type-2 diabetes and to lose weight.

In your body, these medicines work in two ways. They reduce your appetite, so you feel less like eating. They also slow how fast your stomach empties, so food stays in your stomach longer and you feel full sooner. This is why weight loss is a common effect.

If you take one of these medicines and you are planning surgery, it matters to your surgical team. These medicines are increasingly common, so surgeons see more and more patients using them around the time of an operation [1]. One reason they matter is the effect on your stomach: because food empties more slowly, your anaesthetic team needs to know about it when planning your care [2].

Research into these medicines and joint replacement surgery is still growing. Some studies suggest possible benefits, such as a lower risk of infection after hip or knee replacement [3], while other findings are mixed and more research is needed [4]. No single picture has settled yet.

You do not need to stop your medication before surgery on your own. Current advice is that stopping these medicines before a procedure is not recommended, because it can affect your blood sugar control and your weight [5]. Your team will talk with you about your specific plan.

How it affects your surgery and anaesthetic

The main thing to know is about your stomach. These medicines slow how fast your stomach empties. That means food can stay there longer than expected, even after you have fasted. If you are sedated during your operation, stomach contents can come back up and enter your lungs. This is called aspiration. It is a known risk with any anaesthetic, and these medicines can add to it.

Your anaesthetic team manages this carefully. They follow guidelines about pausing the medication around your operation and about fasting for longer than usual. Some teams also check your stomach with an ultrasound scan before the procedure, to see whether food or fluid is still sitting there. Studies have found that most people taking these medicines have some leftover food or fluid in the stomach, even after normal fasting [1]. Whether this actually leads to food or fluid entering the lungs is much less clear, and the research on that point is inconsistent [1].

There is also some encouraging news about recovery. Studies looking at people having hip or knee replacement found that those taking these medicines around the time of surgery did not have a consistent increase in the need for further surgery in the short term [2]. Some studies also found a lower risk of infection after the operation [2]. For hand surgery such as carpal tunnel release, one study found a small reduction in wound healing problems, and no increase in other complications in the first 90 days [3].

Your team works together to plan this with you. That includes your surgeon, your anaesthetist, and if needed the doctor who manages your diabetes. The goal is a plan tailored to you, so your medication, your fasting instructions and your operation all line up safely. Researchers are still working out the best way to care for people on these medicines around surgery [4], so your team will keep up to date and talk you through exactly what to do before your operation.

What you should do

If you take a GLP-1 medication and you are planning surgery, tell everyone involved in your care. That means your surgeon, your anaesthetist and your GP. It also helps to tell the doctor who prescribed the medication, because they manage your diabetes or weight plan and will be part of the decision.

Do not stop taking your medication on your own. If you think it might need to be paused, ask the doctor who prescribed it first. Stopping it without advice can affect your blood sugar and your weight.

Your team will give you clear instructions before your operation. These may cover whether to pause the medication, and for how long. They will also cover fasting, which may be longer than usual because these medicines slow your stomach. Follow those instructions exactly as written.

Your care is planned as a team. Because these medicines affect how your stomach empties, your surgeon and anaesthetist work together with the doctor who manages your diabetes to build a plan that suits you [1]. Researchers are still working out the best way to care for people on these medicines around surgery [2], so your team will keep up to date.

If anything is unclear, ask. No question about your medication is too small when an operation is involved.

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.

References
  1. The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations. *The Journal of Arthroplasty*. 2024. 10.1016/j.arth.2023.12.002
  2. 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. 10.3904/kjim.2025.277
  3. Glucagon-like peptide-1 receptor agonists in total joint arthroplasty: a comprehensive systematic review of what orthopaedic surgeons should know. *Arthroplasty*. 2026. 10.1186/s42836-026-00375-w
  4. Impact of Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes in Arthroplasty: A Systematic Review. *The Journal of Arthroplasty*. 2025. 10.1016/j.arth.2025.07.015
  5. Periprocedural use of GLP-1 receptor agonists: ANZCA Clinical Practice Recommendations. *ANZCA*. 2025.
  6. Perioperative anesthesia management of GLP-1 receptor agonists: a systematic review of potential risks. *Perioperative Medicine*. 2026. 10.1186/s13741-026-00662-9
  7. Impact of Perioperative Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes Following Carpal Tunnel Release. *Journal of Hand Surgery Global Online*. 2025. 10.1016/j.jhsg.2025.100746
  8. GLP-1 agonists: a new hope for patients, a new challenge for anaesthetists. *Anaesthesiology Intensive Therapy*. 2025. 10.5114/ait/203167
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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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.

Creative Commons may be contacted at creativecommons.org.