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Los medicamentos GLP-1 (Ozempic, Wegovy) y su cirugía

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If you take a GLP-1 medication (such as semaglutide — Ozempic or Wegovy) and you are having an operation: what these drugs do, why they matter for your anaesthetic (delayed stomach emptying and aspiration risk), and what you should do before surgery.

Updated Sep 2026
Una pluma de inyección médica.
Los medicamentos GLP-1 son cada vez más frecuentes y tienen implicaciones que conviene comentar antes de la cirugía y la anestesia. Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

¿Qué es este medicamento?

Los medicamentos GLP-1 son un grupo de medicamentos que quizá conozca por nombres comerciales como Ozempic o Wegovy. Su nombre completo es agonistas del receptor del péptido similar al glucagón tipo 1, o agonistas del GLP-1 para abreviar. Se utilizaron primero para tratar la diabetes tipo 2, una enfermedad en la que los niveles de azúcar en sangre están demasiado altos. Hoy también se usan ampliamente para ayudar a perder peso a las personas que viven con obesidad [1].

Estos medicamentos imitan una hormona natural que su cuerpo libera después de comer. Esa hormona hace dos cosas principales. Reduce el apetito, de modo que se siente lleno antes y come menos. También hace que el estómago se vacíe más despacio, lo que mantiene la sensación de saciedad durante más tiempo [2]. El resultado para muchas personas es una pérdida de peso constante y un mejor control del azúcar en sangre [3].

Si usted toma uno de estos medicamentos y tiene prevista una cirugía, es importante para su equipo médico. Estos medicamentos son cada vez más frecuentes, y los cirujanos atienden cada vez a más pacientes que los toman [4]. La investigación sobre cómo afectan a la cirugía sigue creciendo, y algunos hallazgos todavía no coinciden entre sí [5] [6]. Lo que se sabe hasta ahora es, en términos sencillos, mayoritariamente tranquilizador: los estudios que han seguido a pacientes con prótesis articulares no han encontrado un aumento claro de los problemas a corto plazo después de la cirugía [7] [8], y algunas investigaciones relacionan estos medicamentos con una menor probabilidad de problemas en la herida o de infección [9] [10]. Las guías actuales indican que no es necesario dejar el medicamento antes de una intervención programada, porque suspenderlo puede alterar su azúcar en sangre y su progreso en la pérdida de peso [11].

El resto de esta página explica lo que esto significa para usted en torno al momento de su operación.

Cómo afecta a su cirugía y a la anestesia

Lo principal que cambian estos medicamentos en torno a la cirugía es su estómago. Como hacen que el estómago se vacíe más despacio, los alimentos y los líquidos pueden permanecer en él más tiempo del que usted o su equipo médico esperarían. La mayoría de los estudios ha encontrado que las personas que toman estos medicamentos tienen más contenido residual en el estómago de lo esperado [12]. Esto es importante porque, durante una anestesia, el contenido del estómago puede subir y pasar a los pulmones. Esto se llama aspiración. Es un riesgo conocido de cualquier anestesia, y estos medicamentos pueden aumentarlo, aunque las pruebas que los relacionan con casos reales de aspiración siguen siendo contradictorias [12].

Su anestesista lo tiene en cuenta al planificar. La recomendación australiana actual es seguir tomando el medicamento y tomar solo líquidos claros durante las 24 horas anteriores a la cirugía, de modo que el tiempo de ayuno habitual queda dentro de esas 24 horas. Algunos equipos también revisan el estómago con una ecografía antes de la operación. La investigación ha estudiado estas medidas y ha encontrado que pueden ayudar a reducir el contenido residual del estómago en algunos pacientes [13]. Su equipo decidirá cuáles se aplican en su caso.

También hay buenas noticias sobre la recuperación. Los estudios de personas operadas de prótesis de cadera o de rodilla mientras tomaban estos medicamentos no han encontrado un aumento constante de las tasas de revisión a corto plazo [8]. Algunas investigaciones los relacionan con una menor probabilidad de infección después de la operación, incluida la infección alrededor de la nueva articulación [3] [8]. En la cirugía de la mano, como la liberación del túnel carpiano, un estudio encontró una pequeña reducción de los problemas de cicatrización de la herida y ningún aumento de otras complicaciones tempranas [10].

Su equipo médico gestiona todo esto con cuidado. Cirujanos, anestesistas y especialistas en diabetes trabajan juntos para planificar el enfoque más seguro para usted [2]. Los investigadores todavía están estudiando cuál es la mejor manera de atender a las personas que toman estos medicamentos en torno a la cirugía [14]. Por ahora, el mensaje práctico es sencillo: dígale a su equipo que toma este medicamento, siga exactamente sus instrucciones de ayuno, y ellos se encargarán del resto.

Qué debe hacer

Siga tomando su medicamento GLP-1 como de costumbre antes de la operación; no lo suspenda. Durante las 24 horas anteriores a la cirugía, tome solo líquidos claros y ningún alimento sólido. Los líquidos claros son bebidas a través de las cuales se puede ver, como agua, zumo de manzana claro, o té o café solo, sin leche. El tiempo de ayuno habitual antes de una anestesia forma parte de esas 24 horas, no se añade después: hacia el final, su anestesista le dirá cuándo dejar también los líquidos claros. Esto sigue la recomendación australiana actual de anestesia (ANZCA).

Siga tomando su medicamento tal como se lo han recetado, e informe de que lo toma a todas las personas que participan en su atención. Eso incluye a su cirujano, a su anestesista y a su médico de cabecera. También incluye al médico que le recetó el medicamento, ya sea su médico de cabecera o un especialista.

No deje de tomarlo por su cuenta. Suspenderlo puede afectar a su azúcar en sangre y a su progreso en la pérdida de peso.

Antes de la intervención, su equipo le dará instrucciones claras. Siga las indicaciones sobre su medicamento y sobre el ayuno previo exactamente como están escritas. Ayunar significa no comer ni beber durante un tiempo determinado antes de la cirugía. Estas medidas ayudan a mantener el estómago vacío y reducen los riesgos de la anestesia.

Si tiene cualquier duda, pregunte. Su cirujano, su anestesista y su médico de cabecera trabajan juntos para planificar el enfoque más seguro para usted. Ninguna pregunta es demasiado pequeña cuando se trata de su medicamento y su operación.

Referencias

[1] GLP-1 Receptor Agonists in Orthopaedic Surgery: Implications for Perioperative Care and Outcomes. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01287

[2] Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia. The Korean Journal of Internal Medicine. 2026. DOI: 10.3904/kjim.2025.277

[3] Semaglutide and Other GLP-1 Agonists: A Boon for the Arthroplasty Industry?. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.014

[4] The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.002

[5] Glucagon-Like Peptide-1 Receptor Agonists: Have We Found the Holy Grail for Total Joint Arthroplasty?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.10.027

[6] Impact of Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes in Arthroplasty: A Systematic Review. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.07.015

[7] GLP-1 receptor agonist therapy is not associated with adverse events following shoulder surgery: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.12.005

[8] Glucagon-like peptide-1 receptor agonists in total joint arthroplasty: a comprehensive systematic review of what orthopaedic surgeons should know. Arthroplasty. 2026. DOI: 10.1186/s42836-026-00375-w

[9] The Association Between Glucagon-Like Peptide-1 Receptor Agonists and Postoperative Complications After Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.06.083

[10] Impact of Perioperative Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes Following Carpal Tunnel Release. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100746

[11] Periprocedural use of GLP-1 receptor agonists: ANZCA Clinical Practice Recommendations. ANZCA. 2025.

[12] Perioperative anesthesia management of GLP-1 receptor agonists: a systematic review of potential risks. Perioperative Medicine. 2026. DOI: 10.1186/s13741-026-00662-9

[13] Peri-Procedural Fasting and Gastric Ultrasound Strategies in Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist Users: A Systematic Review With Qualitative Synthesis. Cureus. 2026. DOI: 10.7759/cureus.108216

[14] GLP-1 agonists: a new hope for patients, a new challenge for anaesthetists. Anaesthesiology Intensive Therapy. 2025. DOI: 10.5114/ait/203167

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Glucagon-like peptide-1 receptor agonists induce delayed gastric emptying [1].
  • The pharmacological mechanisms of GLP-1 RA-induced delayed gastric emptying have clinical implications for perioperative aspiration risk during anesthesia [1].
  • Interdisciplinary collaboration between endocrinologists and anesthesiologists is emphasized for safe and individualized perioperative management of patients on GLP-1 RAs [1].
  • GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight [2].
  • Further high-quality studies are called for to address the optimal perioperative care of patients on GLP-1RAs due to their increasing popularity in patients with obesity [3].
  • Conflicting findings in the literature highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes [4].
  • Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists [5].
  • It is important for arthroplasty surgeons to understand the implications of GLP-1 agonist use in the perioperative period [5].
  • GLP-1 agonist use should not be a contraindication for proceeding with total shoulder arthroplasty based on data showing no association with adverse events following shoulder surgery [6].
  • Elective preprocedural cessation of GLP-1RAs and GLP-1/GIPRAs is not recommended due to insufficient data supporting cessation and risks of hyperglycaemia and compromised weight control [7].
  • The variability in available studies, potential confounding factors, and severe heterogeneity of conclusions emphasize the need for more high-quality evidence-based primary research to optimize perioperative management of patients taking GLP-1 RAs [8].
  • GLP-1 agonists have effects on bone health that are relevant to perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery [9].
  • GLP-1RA use suggests a potential benefit for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty [10].

Effects on Surgery and Recovery

Perioperative Anesthesia and Gastric Emptying

  • Authors call for further high-quality studies to address the optimal perioperative care of patients on GLP-1RAs due to their increasing popularity in patients with obesity [3].
  • Available observational evidence suggests that extended GLP-1 RA withholding, 24-hour clear liquid diets, and pre-procedural gastric POCUS may be associated with reduced residual gastric content in selected patient populations [14].

Arthroplasty Outcomes

  • Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists, making it important to understand the implications of their use in the perioperative period [5].
  • Conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes in arthroplasty [4].
  • Findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty [10].
  • While GLP-1 receptor agonists show potential to reduce postoperative complications in total joint arthroplasty, findings remain inconsistent, and further research is needed to clarify their impact on outcomes and establish perioperative management guidelines [11].
  • Preoperative glucagon-like peptide-1 receptor agonist use may be linked to reduced readmission risk following joint arthroplasty, without evidence of increased postoperative medical harm [12].
  • Semaglutide and other GLP-1 agonists may increase the number of eligible candidates for elective total joint arthroplasty by enabling weight loss and improving diabetic control [13].
  • Semaglutide and other GLP-1 agonists may potentially reduce postoperative complications such as sepsis and prosthetic joint infections [13].
  • Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty is not associated with a consistent increase in short-term revision rates [16].
  • Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty may be associated with a reduced risk of postoperative infection [16].

Other Orthopedic Procedures

  • Based on data from a systematic review and meta-analysis, GLP-1 agonist use should not be a contraindication for proceeding with total shoulder arthroplasty [6].
  • Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following carpal tunnel release [15].
  • Perioperative GLP-1RA use did not increase the odds of any other 90-day postoperative complications following carpal tunnel release [15].

Bone Health

  • A narrative review explores the mechanisms of action of GLP-1 agonists, their effects on bone health, and the implications of their use in perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery [9].
  • Exenatide is the best option agent with regard to the risk of fracture [17].

Practical Considerations

Perioperative Anesthesia and Gastric Emptying

  • Delayed gastric emptying induced by GLP-1 RAs has implications for perioperative aspiration risk during anesthesia [1].

Medication Management

Arthroplasty Outcomes and Eligibility

  • Conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes [4].

Shoulder Surgery

Bone Health and Spine Surgery

Key Evidence

  • [L4] This review summarizes the pharmacological mechanisms and clinical implications of GLP-1 RA-induced delayed gastric emptying, evaluates current literature on perioperative aspiration risk, and emphasizes the importance of interdisciplinary collaboration between endocrinologists and anesthesiologists to ensure safe and individualized perioperative management. [1] (10.3904/kjim.2025.277)
  • [Paper] While efficacious, GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight. [2] (10.2106/jbjs.rvw.23.00167)
  • [L4] Due to the increasing popularity of GLP-1RAs in patients with obesity, the authors call for further high-quality studies to address the optimal perioperative care of patients on GLP-1RAs. [3] (10.5114/ait/203167)
  • [L4] However, conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes. [4] (10.1016/j.arth.2025.07.015)
  • [L5] Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists, making it important to understand the implications of their use in the perioperative period. [5] (10.1016/j.arth.2023.12.002)
  • [L1] Based on this data, GLP-1 agonist use should not be a contraindication for proceeding with TSA. [6] (10.1016/j.jse.2025.12.005)
  • [L2] The variability in available studies, potential confounding factors, and the severe heterogeneity of conclusions all emphasize the need for more high-quality evidence-based primary research to optimize perioperative management of patients taking GLP-1 RAs. [8] (10.1186/s13741-026-00662-9)
  • [L4] This narrative review explores the mechanisms of action of GLP-1 agonists, their effects on bone health, and the implications of their use in perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery. [9] (10.1177/15563316261438492)
  • [L1] These findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty. [10] (10.1016/j.arth.2025.09.054)
  • [L5] The paper concludes that while GLP-1 receptor agonists show potential to reduce postoperative complications in total joint arthroplasty, findings remain inconsistent, and further research is needed to clarify their impact on outcomes and establish perioperative management guidelines. [11] (10.1016/j.arth.2025.10.027)
  • [L1] Preoperative glucagon-like peptide-1 receptor agonist use may be linked to reduced readmission risk following joint arthroplasty, without evidence of increased postoperative medical harm. [12] (10.1016/j.arth.2025.11.036)
  • [L5] Semaglutide and other GLP-1 agonists may increase the number of eligible candidates for elective total joint arthroplasty by enabling weight loss and improving diabetic control, while also potentially reducing postoperative complications such as sepsis and prosthetic joint infections. [13] (10.1016/j.arth.2023.12.014)
  • [L4] Available observational evidence suggests that extended GLP-1 RA withholding, 24-hour clear liquid diets, and pre-procedural gastric POCUS may be associated with reduced residual gastric content in selected patient populations. [14] (10.7759/cureus.108216)
  • [L3] Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following CTR and did not increase the odds of any other 90-day postoperative complications. [15] (10.1016/j.jhsg.2025.100746)
  • [L4] Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty is not associated with a consistent increase in short-term revision rates and may be associated with a reduced risk of postoperative infection. [16] (10.1186/s42836-026-00375-w)
  • [L1] Exenatide is the best option agent with regard to the risk of fracture. [17] (10.1007/s00198-018-4649-8)

References

[1] Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia. The Korean Journal of Internal Medicine. 2026. DOI: 10.3904/kjim.2025.277

[2] Glucagon-like Peptide-1 Agonists. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.23.00167

[3] GLP-1 agonists: a new hope for patients, a new challenge for anaesthetists. Anaesthesiology Intensive Therapy. 2025. DOI: 10.5114/ait/203167

[4] Impact of Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes in Arthroplasty: A Systematic Review. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.07.015

[5] The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.002

[6] GLP-1 receptor agonist therapy is not associated with adverse events following shoulder surgery: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.12.005

[7] Periprocedural use of GLP-1 receptor agonists: ANZCA Clinical Practice Recommendations. ANZCA. 2025.

[8] Perioperative anesthesia management of GLP-1 receptor agonists: a systematic review of potential risks. Perioperative Medicine. 2026. DOI: 10.1186/s13741-026-00662-9

[9] GLP-1 Agonists in Orthopedic Surgery: A Narrative Review of Bone Health and Surgical Implications. HSS Journal. 2026. DOI: 10.1177/15563316261438492

[10] The Impact of Glucagon-Like Peptide-1 Receptor Agonist Use on Clinical Outcomes After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of 346,899 Patients. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.09.054

[11] Glucagon-Like Peptide-1 Receptor Agonists: Have We Found the Holy Grail for Total Joint Arthroplasty?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.10.027

[12] Glucagon-Like Peptide-1 Receptor Agonists, Readmission, and Postoperative Complications in Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.11.036

[13] Semaglutide and Other GLP-1 Agonists: A Boon for the Arthroplasty Industry?. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.014

[14] Peri-Procedural Fasting and Gastric Ultrasound Strategies in Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist Users: A Systematic Review With Qualitative Synthesis. Cureus. 2026. DOI: 10.7759/cureus.108216

[15] Impact of Perioperative Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes Following Carpal Tunnel Release. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100746

[16] Glucagon-like peptide-1 receptor agonists in total joint arthroplasty: a comprehensive systematic review of what orthopaedic surgeons should know. Arthroplasty. 2026. DOI: 10.1186/s42836-026-00375-w

[17] Glucagon-like peptide-1 receptor agonists and fracture risk: a network meta-analysis of randomized clinical trials. Osteoporosis International. 2018. DOI: 10.1007/s00198-018-4649-8

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3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.