Fasting and surgery timing (FaST) audit

Abstract

Summary Background & aims International guidance advocates the avoidance of prolonged preoperative fasting due to its negative impact on perioperative hydration. This study aimed to assess the adherence to these guidelines for fasting in patients undergoing elective and emergency surgery in the East Midlands region of the UK. Methods This prospective audit was performed over a two-month period at five National Health Service (NHS) Trusts across the East Midlands region of the UK. Demographic data, admission and operative details, and length of preoperative fasting were collected on adult patients listed for emergency and elective surgery. Results Of the 343 surgical patients included within the study, 50% (n = 172) were male, 78% (n = 266) had elective surgery and 22% (n = 77) underwent emergency surgery. Overall median fasting times (Q1, Q3) were 16.1 (13.0, 19.4) hours for food and 5.8 (3.5, 10.7) hours for clear fluids. Prolonged fasting >12 h was documented in 73% (n = 250) for food, and 21% (n = 71) for clear fluids. Median fasting times from clear fluids and food were longer in the those undergoing emergency surgery when compared with those undergoing elective surgery: 13.0 (6.4, 22.6) vs . 4.9 (3.3, 7.8) hours, and 22.0 (14.0, 37.4) vs . 15.6 (12.9, 17.8) hours respectively, p < 0.0001. Conclusions Despite international consensus on the duration of preoperative fasting, patients continue to fast from clear fluids and food for prolonged lengths of time. Patients admitted for emergency surgery were more likely to fast for longer than those having elective surgery.

Association of a Liberal Fasting Policy of Clear Fluids Before Surgery With Fasting Duration and Patient Well-being and Safety

“…[1][2][3] Studies have shown that guideline implementation is suboptimal: in many hospitals, patients still fast 5 to 6 hours for clear fluids, leading to negative metabolic sequelae. 2,[4][5][6][7][8][9][10] Inadequate implementation is, among other things, caused by fear of aspiration, anxiety, and loose flexibility in operating room scheduling. 7 Although aspiration can lead to aspiration pneumonia and even death, its reported incidences are between 1 and 10 in 10 000 elective procedures.…”

Enhanced recovery after surgery: Current status and future progress

“…However, recent evidence suggests that patients should be allowed to drink water if they are thirsty in the preoperative period [36][37][38]. Despite guidance, there is evidence that these fasting times are often poorly adhered to [39,40].…”

Effects of Preoperative Oral Electrolyte‐Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

“…Studies found that malnutrition caused discomfort and anxiety, prolonged length of hospital stay, and affected clinical recovery 4 , 5 . In addition, electrolyte disorders had increased risks of delirium, myocardial infarction, and surgical site infection after orthopaedic surgeries 4 , 6 . It was crucial to apply nutrition management to prevent malnutrition or electrolyte disorders after surgery.…”