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Do I need to stop my GLP-1 before surgery?
Most patients hold at least one dose. But that call belongs to your care team, not to you alone and not to me alone.
The right plan depends on which medicine you take, how recently your dose changed, and whether you are having stomach symptoms.
Here is what I tell patients across the desk in Franklin: tell me you are on it, tell me the exact name, and we will build the plan with the doctor who prescribes it.
Never skip, delay, or restart a dose on your own. That is the one rule I ask every patient to follow.
Why does a GLP-1 before surgery matter for anesthesia?
These medicines slow how fast your stomach empties. A stomach that still holds food or liquid at the start of anesthesia is a real safety problem.
Under anesthesia, the reflexes that guard your airway switch off. If stomach contents come back up, they can reach the lungs. That is called aspiration. It is rare, and serious enough that every anesthesia team plans around it.
GLP-1 stands for glucagon-like peptide-1. It is a gut hormone that tells your brain you are full and slows your stomach down. Semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), and liraglutide (Victoza, Saxenda) all work this way.
The same effect that keeps you satisfied after a small meal is the effect your surgical team has to plan for.
Who carries the higher risk
- You started the medicine recently, or your dose went up in the last few weeks
- You are having nausea, vomiting, bloating, or reflux
- You take a weekly shot rather than a daily one
- You have another condition that slows digestion, such as diabetes with gastroparesis
If none of those describe you, your risk is lower. Your plan may look different from your neighbor’s.
What the national guidance says now
The guidance changed, and the change matters. In 2023, the American Society of Anesthesiologists advised holding weekly shots for a week beforehand and daily forms on the day of surgery.
In late 2024, five societies issued joint guidance that stepped away from automatic holds. Most patients can stay on the medicine before elective surgery. Higher risk patients take clear liquids only for 24 hours beforehand.
Those groups made a fair point that gets missed. Pausing the drug can cost you blood sugar control. And a blanket hold applied only to patients carrying extra weight is not a defensible standard.
How I handle a GLP-1 before surgery in my practice
My approach sits between the old rule and the new one. I want the medicine in the surgical conversation at your first pre-operative visit. I want your prescribing doctor in the loop before anything changes.
For most of my patients on a weekly shot, that has meant holding the dose the week before surgery, coordinated with the prescriber.
For a patient with a steady dose and no stomach symptoms, the anesthesia team may be fine continuing it with a clear liquid day beforehand.
After more than twenty years and 700 joint replacements a year, I would rather over-communicate about a drug like this than hear about it on surgery morning.
Why timing a GLP-1 before surgery is a team decision
Three people own a piece of this: the doctor who prescribes the medicine, the anesthesiologist who will manage your airway, and me.
When the three of us are not talking, the usual result is a delay or a cancelled case on the morning of surgery. I have watched both happen. Neither is worth it.
Bring the pen, the box, or the app on your phone to your pre-operative visit. The name, the schedule, and the date of your last dose is all we need to start.
Does staying on a GLP-1 make joint replacement safer?
The orthopaedic data so far points that way more often than not. That surprises patients who assume the drug is a liability on the surgery schedule.
A 2026 review pooled thirteen studies covering more than 1.4 million hip and knee replacements. Patients on a GLP-1 had lower rates of joint infection, revision surgery, and readmission within 90 days. The review found no rise in aspiration.
Work focused on patients with severe obesity points the same way. One hip replacement study found a 90 day infection rate of 1.6 percent in GLP-1 users, against 3.2 percent in patients not taking one. Joint infection is the complication I work hardest to prevent, so a gap like that gets my attention.
One honest caution. That same 2026 review found a higher one year risk of fracture around the implant, mostly in knee patients. Researchers are still sorting out why. It is a reason to watch bone density and strength, not a reason to avoid the drug.
Will I lose muscle before surgery, and does it matter?
Yes on both counts. This is the part I worry about most.
Fast weight loss takes muscle along with fat. Published trials put lean tissue at roughly 25 to 40 percent of the total weight lost.
Your quadriceps, glutes, and core are the scaffolding that protects a worn joint. They are also the engine that drives your recovery. Losing that scaffolding while your cartilage wears down is the worst of both worlds.
The reassuring part is that this is preventable.
What I ask patients on a GLP-1 to do before surgery
- Strength train two to three days a week, with real attention to the legs and hips
- Anchor every meal around a protein source; your primary care doctor or a dietitian can set a target for your size
- Keep walking, but do not let walking stand in for resistance work
- Track your strength and function, not only the number on the scale
The stronger you arrive at surgery, the better you do. That has held true for every patient I have operated on. It holds whether your surgery is next month or years away.
Can weight loss change whether I qualify for surgery?
It can. For some patients it is the difference between a delayed surgery and a scheduled one.
Weight sits right on the joint. Every pound you carry is roughly four pounds of force across the knee with each step. Lose fifteen pounds and the knee feels sixty pounds lighter.
Most surgery centers set a threshold for elective joint replacement, often a body mass index around 40. Above that line, infection and medical complication rates climb. I steer patients toward a BMI under 40, worked out with their primary care doctor or a dietitian rather than alone.
A GLP-1 can be a sensible part of that plan. It is not the whole plan.
What these medicines will not do for your arthritis
They will not regrow cartilage. Arthritis is the absence of something. Once cartilage is gone, no drug puts it back.
If your pain settles down on one of these medicines, that is real and it is good news. Just do not read a quiet joint as a healthy joint. Keep your follow-up visits so we can track what the joint is doing on imaging.
Weight loss also will not fix a bowed leg, a worn implant, or a mechanical problem inside the knee. Those still call for knee replacement or hip replacement when the time comes.
For the fuller research picture on delaying surgery, I wrote a companion piece on whether GLP-1s can help you avoid joint replacement. The American Academy of Orthopaedic Surgeons also publishes a plain-language guide to weight and surgical risk.
What to bring to your pre-operative visit
- The exact name of your medicine, and whether it is daily or weekly
- The date of your most recent dose
- Any dose increase in the last month
- Any nausea, vomiting, bloating, or reflux
- How much weight you have lost, and over what period
- The name and phone number of the doctor who prescribes it
- Whether you have started or stopped strength training
Bring that list and we can settle the plan in one visit instead of three phone calls.
Talking through a GLP-1 before surgery in Middle Tennessee
A growing share of the patients I see in Franklin already take one of these medicines. Many drive in from Nashville, Brentwood, Columbia, Spring Hill, and Murfreesboro. Few have ever been asked about it in a surgical context.
That conversation is worth having early. If you are weighing hip or knee replacement and you are on a GLP-1, bring it to the consultation and we will plan around it properly.
Ready to talk it through? Dr. Calendine is accepting new patients at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067. No referral required. Schedule a consultation or call (615) 791-2630.
Medical disclaimer: This article is for educational purposes only and is not a substitute for individual medical advice. Decisions about a GLP-1 before surgery should be made with your orthopaedic surgeon, your anesthesia team, and the doctor who prescribes the medicine. Never change the timing of a prescribed drug on your own. In a medical emergency, call 911.
