UK Nationwide Audit Links GLP-1 Receptor Agonists to 11-Fold Rise in Perioperative Regurgitation

The GLIMPSE network screened adults at 119 sites for GLP-1 RA exposure within three months of elective or emergency procedures. Data captured drug source, cessation timing, airway strategy, and the composite of regurgitation or pulmonary aspiration. Among 1,348 exposed patients, 19 events occurred; 17 were regurgitations and two were aspirations, predominantly at awakening. More than 40% obtained prescriptions via online pharmacies rather than GPs, complicating preoperative reconciliation.

Delayed gastric emptying is the established mechanism, yet cessation guidance varied widely: only 32% of patients were instructed to stop therapy. This heterogeneity aligns with earlier observational reports from Australia and the United States that documented inconsistent fasting protocols and elevated residual gastric volumes on ultrasound. Absolute risk remains low, but the relative increase is clinically meaningful given the rapid rise in GLP-1 RA prevalence.

Future work must move beyond single-country audits to multicenter RCTs comparing standardized hold intervals against point-of-care gastric ultrasound. Regulatory bodies should also track online prescribing patterns, as these sources rarely interface with perioperative teams. Updated society guidelines incorporating these data are expected within 12–18 months.