M. Kochis1, C. Bizimana1, J. L. Zitsman3, J. S. Pratt2, C. L. Griggs1 1Massachusetts General Hospital, Pediatric Surgery, Boston, MA, USA 2Stanford University, Pediatric Surgery, Palo Alto, CA, USA 3Columbia University College Of Physicians And Surgeons, Pediatric Surgery, New York, NY, USA
Introduction:
Glucagon-Like Peptide-1 agonists (GLP-1A) are a class of drugs which are gaining widespread popularity for the treatment of diabetes and obesity. Even in light of recent guidelines from the American Society of Anesthesiologists regarding their pre-operative management, the optimal use of these drugs in the context of bariatric surgery, and especially in pediatric bariatric populations, is yet to be established. We sought to characterize current practice patterns of GLP-1A use at pediatric bariatric centers across the United States.
Methods:
We employ a Delphi technique to integrate knowledge from a purposive sample of 44 surgeons and obesity medicine physicians from across the country who currently work with pediatric bariatric populations. We distributed an online survey asking about their current practices 1) starting GLP1-A in patients considering weight loss surgery, 2) holding them prior to elective operations, and 3) restarting them after bariatric surgery. Data collection is ongoing at the time of abstract submission. Responses were summarized with descriptive statistics and content analysis of free text.
Results:
Preliminary results include 12 responses (27% response rate) representing 12 institutions, with a mean practice size of 1.9 (range 1–4) surgeons and a mean of 33 (range 6–55) bariatric operations per year. Most (83%) respondents sometimes prescribe GLP-1A for patients considering weight loss surgery, but the specific indications vary greatly. Practices for holding GLP-1A prior to surgery also vary, from not holding at all to holding for two weeks pre-operatively. Half of respondents sometimes restart GLP-1A after bariatric surgery; of those, indications are weight loss failure/plateau (67%), weight regain (67%), and pre-operative diabetes/insulin resistance (50%). Free-response themes include still-evolving pre-operative utilization patterns, difficulty with insurance coverage, concerns about aspiration when administered too soon pre-operatively, and a lack of data underscoring GLP-1A use in the pre-operative and post-operative periods.
Conclusion:
There is wide variation in GLP-1A use among pediatric bariatric patients nationally. They are commonly prescribed to patients undergoing weight loss surgery for variable indications. Some surgeons are concerned about these drugs causing delayed gastric emptying, but there is inconsistency in whether and how long patients hold them pre-operatively. GLP-1A are occasionally restarted post-operatively for weight loss plateau, weight regain, and pre-operative diabetes mellitus. Surgeons acknowledge a lack of data guiding their practices. Given the increasing use of these medications for weight loss indications, this wide variation in practice underscores a need for clinical trials to determine the safest and most effective use of GLP-1A in the pre-operative and post-operative periods and for practice guidelines specific to pediatric bariatric contexts.