Ozempic and Surgery: And What You Need to Know

The Problem Nobody Told You About

So here’s the deal: GLP-1 drugs slow down your digestion. That’s part of how they work—food hangs around in your stomach longer, you feel fuller, you eat less. Great for weight loss. Terrible for surgery.

Think about what happens when you go under anesthesia. Your body basically shuts off all those automatic reflexes that keep you safe. Including the one that stops food from going down your windpipe instead of your esophagus.

Now imagine there’s still a bunch of food sitting in your stomach because your medication kept it there longer than normal. You’re unconscious on the operating table. That food comes back up. And instead of coughing it out like you normally would, it slides right into your lungs.

Doctors call this pulmonary aspiration. It can wreck your lungs, cause pneumonia, or kill you.

Why the Usual Fasting Rules Don’t Cut It

Your surgeon probably told you: nothing to eat after midnight, or stop eating 6-8 hours before. That works fine for most people. Stomach empties, you’re good to go.

But your stomach doesn’t play by those rules anymore when you’re on Ozempic or similar meds. You could skip dinner entirely and still have yesterday’s lunch sitting in there come morning.

Hospitals in the US, Canada, Australia, and New Zealand have been reporting cases like these:

• Patients who fasted 18+ hours. Still had food in their stomachs.
• People throwing up during procedures even though they did everything right.
• Emergency intubations because of aspiration.
• ICU admissions for respiratory failure.

The Guidelines Keep Changing (And That’s Confusing Everyone)

Medical societies have been scrambling to figure this out, and their recommendations have shifted a lot.

June 2023: The First Warning

The American Society of Anesthesiologists put out initial guidance:

• Taking a daily GLP-1? Stop it the day of surgery.
• On a weekly injection like Ozempic? Hold it for a full week before.

October 2024: Multi-Society Update

Five major medical societies got together and released updated recommendations. The new take? Most people can actually keep taking their meds. But there are catches:

Your Situation	What To Do
Stable dose, no stomach issues	Keep taking it, proceed normally
Just started or recently increased dose, having nausea/bloating	Liquids only for 24 hours before surgery
Multiple risk factors	Your procedure might need to be postponed

March 2025: Orthopedic Surgeons Want More Time

A study presented at the AAOS annual meeting found that for hip and knee replacements specifically, patients did best when they stopped Ozempic a full two weeks ahead of surgery. Not one week. Two.

Are You at Higher Risk?

Not everyone on these medications faces the same odds of having problems. Your risk goes up if you:

What To Do If You Have Surgery Coming Up

Talk. To. Everyone.

I cannot stress this enough. Every person involved in your care needs to know about your GLP-1 medication:

• The surgeon
• The anesthesiologist (this one especially)
• Pre-op nurses
• Whoever prescribed your medication in the first place

Some people have shown up for their procedures without mentioning they’re on Ozempic. Surgeries get cancelled at the last second. Or worse, they don’t get cancelled and something goes wrong.

Questions You Need to Ask

Don’t just nod along at your pre-op appointment. Get specific answers:

• How far in advance should I stop my injection?
• Do I need to fast longer than other patients?
• Should I do a liquid-only diet the day before?
• Are you going to check my stomach with ultrasound before we start?
• What’s your backup plan if my stomach isn’t empty?

Actually Follow the Instructions

If they tell you clear liquids only for 24 hours, that means clear liquids only for 24 hours. Not “mostly clear liquids with maybe a little toast.” This isn’t the time to fudge it.

It’s Not Just Major Surgery

Anything involving sedation carries the same concerns:

• Colonoscopies
• Upper endoscopies
• Getting your wisdom teeth out under sedation
• Cosmetic procedures

Same rules apply. Tell them what you’re taking. Follow whatever special instructions they give you.

Wait—Some Researchers Say the Risk Is Overblown

Fair point. Not every study paints a scary picture.

Stanford Medicine looked at insurance data from roughly 250 million people. Their conclusion? The concerns about aspiration risk might be overblown.

A team at Houston Methodist did a meta-analysis of 36 clinical trials. They found GLP-1 drugs only delay stomach emptying by about 36 minutes on average. That’s… not that dramatic, honestly.

One large database analysis calculated the aspiration risk at around 3 per 100,000 patients.

So yes, the risk is real. But it’s probably not as common as the early panic suggested. The bigger issue seems to be when patients and medical teams don’t communicate—or in emergency surgeries where there’s no time to prepare.

Bottom Line

Look, GLP-1 medications have genuinely changed lives for people dealing with diabetes and obesity. Nobody’s saying you shouldn’t take them. But surgery adds a wrinkle that most patients don’t think about.

If you’ve got any procedure that requires anesthesia:

The point here isn’t to scare you out of getting medical care you need. It’s to make sure you get that care without any nasty surprises.

Key Takeaways

Disclaimer: This article is for informational purposes only. It’s not medical advice. Talk to your own doctors before changing anything about your medications or surgical plans.