Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) — including semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro), liraglutide, and dulaglutide — have become one of the most widely prescribed drug classes in the United States. Originally developed for type 2 diabetes, they now carry FDA approval for obesity and weight-related comorbidities. With over 40% of U.S. adults classified as obese per CDC data, and with obesity being a well-documented risk factor for complications in joint replacement and spine surgery, GLP-1 RAs are increasingly relevant to the injured worker population. More than half of patients undergoing total knee and hip arthroplasty meet criteria for obesity or morbid obesity, making preoperative weight management a frontline concern for orthopedic surgeons treating industrial injuries.

Perioperative Risks: Aspiration and Gastric Motility

GLP-1 medications slow gastric emptying — a therapeutic feature for appetite control that becomes a serious anesthetic hazard. The American Society of Anesthesiologists (ASA) has issued guidance recommending that patients on **daily-dose** GLP-1 therapy withhold the medication on the day of elective surgery, and patients on **weekly-dose** formulations withhold it for a full week prior. If a patient on GLP-1 therapy presents with gastrointestinal symptoms on the day of surgery, the ASA recommends either postponing surgery or proceeding with “[full stomach precautions](https://journals.lww.com/jbjsjournal/fulltext/2025/08200/glp_1_receptor_agonists_in_orthopaedic_surgery_.17.aspx).” Research presented at the American Academy of Orthopaedic Surgeons (AAOS) 2025 annual meeting in San Diego suggested an even more conservative window — stopping GLP-1s **14 days** before surgery to adequately reduce aspiration risk. Aspiration complications can include bronchial spasms, pneumonia, and death. In the trauma setting, where surgery cannot be delayed, surgeons should use point-of-care gastric ultrasound and full stomach precautions at the surgeon’s discretion.

Bone Healing and Fusion Concerns

This is where the evidence becomes most consequential for workers’ compensation claims involving spine and fracture surgery.

Spine Surgery: A systematic review and meta-analysis published in the *North American Spine Society Journal (December 2025) pooled data from 13 retrospective cohort studies and found that GLP-1 RA use was associated with a **reduced risk of pseudarthrosis** (failure of bone fusion), with no consistent increase in infection, wound healing complications, cerebrospinal fluid leak, or thromboembolic events. However, the authors cautioned that heterogeneity across studies was notable and causality cannot be inferred. Contradicting these pooled findings, a [study on posterior cervical spine surgery published in *The Spine Journal (September 2025) found that patients on GLP-1 medications had a 4.79 times higher risk of non-union and a 2.12 times higher risk of dysphagia compared to controls. The discrepancy likely reflects differences in surgical approach, patient nutrition status, and GLP-1 exposure timing.

Lower Extremity Fractures: A large retrospective cohort study with two-year follow-up found that perioperative GLP-1 RA use was associated with a modestly higher risk of nonunion following lower extremity fracture fixation, though without increased wound complications. Importantly, GLP-1 use was linked to reduced cardiac arrest and one-year mortality — suggesting that the systemic cardiovascular benefits may outweigh the localized bone healing concern for many patients.

Joint Replacement:  Results are mixed. For total shoulder arthroplasty, patients on GLP-1 RAs showed no increase in length of stay or complications. For total knee arthroplasty, semaglutide was associated with decreased periprosthetic joint infection, sepsis, and readmissions — but also with increased acute kidney injury, pneumonia, myocardial infarction, and hypoglycemic events. Total hip arthroplasty data showed similar infection and readmission benefits without the same medical complication increase.

Nutritional and Muscle Mass Implications

Rapid weight loss from GLP-1 medications — often 10–15% of body mass over 6 to 12 months — can deplete lean muscle along with fat, particularly in patients over 60 or those not performing resistance training. This sarcopenic effect directly undermines postoperative rehabilitation. Muscle mass and function are essential for ambulation after joint replacement and spine surgery, and insufficient protein intake increases the risk of delayed wound healing and infection. For workers’ compensation cases, this creates a practical question: is the injured worker’s nutritional status adequate to support surgical healing? Providers should document total weight loss, duration of GLP-1 use, and whether the patient is supplementing with protein or creatine.

Practical Takeaways for Workers’ Compensation Stakeholders

– – Treating physicians and QMEs should document GLP-1 medication use, duration, total weight loss, and nutritional supplementation in every surgical evaluation for an injured worker.
– – Utilization review organizations should flag GLP-1 use when evaluating requests for spine fusion, fracture fixation, or joint replacement — and ensure preoperative nutrition optimization is addressed in the treatment plan.
– – Claims administrators should be aware that GLP-1-related complications (non-union, revision surgery, aspiration events) may extend claim duration and costs, but that the medications also reduce systemic risks like infection and mortality.
– – The standard hold period** before elective surgery remains debated: the ASA recommends 7 days for weekly formulations, while AAOS research suggests 14 days may be safer. Surgeons and anesthesiologists should coordinate on a case-by-case basis.