Preoperative Fasting Times for Patients Undergoing Caesarean Delivery: Before and After a Patient Educational Initiative

Abstract

Objective: Prolonged preoperative fasting may lead to dehydration, hypoglycaemia, ketoacidosis and delayed recovery. We hypothesised that a patient educational initiative would decrease our preoperative fasting periods for elective caesarean delivery. Methods: This was an observational quality improvement impact study. Elective caesarean patients who delivered during our study period were included in the study, 40 patients in the pre-intervention and 40 patients in the post-intervention groups. Only English-speaking patients were included. We developed a patient educational pamphlet outlining preoperative fasting and analgesic expectations for caesarean delivery that was given to every patient at her preoperative anaesthesia consultation. The pamphlet included the American Society of Anesthesiologists' preoperative fasting and enhanced recovery carbohydrate drink recommendations. The primary outcome measure was intended fasting duration for liquids (defined as time from last reported liquid consumption to scheduled caesarean delivery) before and after the patient educational initiative. Secondary outcomes included solid fasting time, types of liquids and solids consumed. Results: The intended median (interquartile range) fasting time for liquids decreased from 10 (8.9-12) h to 3.5 (2.5-10) h (p<0.001). The fasting period for solids was not significantly different

Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia

“…This means that the actual fasting times for both decreased significantly, but only the actual fasting time for clear fluids decreased by a clinically relevant extent. These findings are in line with an educational initiative carried out with patients undergoing elective caesarean delivery [ 7 ]. In this study by Yurashevich et.al ., the actual fasting time for fluids decreased from 10 (8.9–12) h to 3.5 (2.5–10) h after introducing an educational pamphlet for patients including the recommended fasting times, while the actual fasting time for solids did not change significantly [ 7 ].…”

“…Furthermore, several studies revealed prolonged fasting times as a general problem among adult patients. Despite the current recommendations, actual fasting times of more than 10 h for fluids and 13 h for solids are common [ 7 – 9 , 13 – 15 ].…”

“…However, despite our quality-improvement procedures, the actual fasting time for solids decreased only slightly, thereby confirming the results of the study by Yurashevich et.al. in pregnant women [ 7 ].…”

“…Prolonged fasting times are often due to a difference between instructed and actual fasting times [ 6 , 7 ]. Previous studies have shown that this is a consequence of patients being misinformed, unintentional noncompliance as well as inadequate implementation of the current guidelines by the medical staff [ 8 – 11 ].…”

Starvation in the midst of plenty… of caesarean deliveries

“…The rollout of an educational pamphlet regarding preoperative fasting, written in plain language and given to patients on the evening before their elective CDs, has significantly reduced median fasting times for clear fluids in an American study. 9 In that observational quality improvement impact study, the median fasting time for fluids declined from 10 hours (IQR 8.9-12) to 3.5 hours (IQR 2.5-10) after the introduction of the pamphlet (p < 0.001). For various reasons, this study's findings may not be generalisable to the South African situation, and another means of patient education may be more appropriate.…”