Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study

Abstract

BACKGROUND: During a surgical procedure, patients are often subjected to fasting for times that are more prolonged than the ideal, which may lead to complications. OBJECTIVE: To evaluate the duration of perioperative fasting and its association with postoperative complications, length of hospital stay (LOS) and mortality among gastric and colorectal cancer patients. DESIGN AND SETTING: Cohort study developed in a surgical oncology hospital in the city of Natal (Rio Grande do Norte, Brazil). METHODS: Patients aged over 18 years were included. The Clavien-Dindo surgical complication scale was used to evaluate occurrences of postoperative complications. LOS was defined as the number of days for which patients stayed in the hospital after surgery, or until the day of death. RESULTS: Seventy-seven patients participated (59.8 ± 11.8 years; 54.5% females; 70.1% with bowel tumor). The incidences of postoperative complications and death were 59.7% and 3.9%, respectively. The duration of perioperative fasting was 59.0 ± 21.4 hours, and it was higher among non-survivors and among patients with prolonged hospital stay (≥ 6 days). For each one-hour increase in the durations of perioperative and postoperative fasting, the odds of prolonged hospitalization increased by 12% (odds ratio, OR = 1.12; 95% confidence interval, CI 1.04-1.20) and 5% (OR = 1.05; 95% CI 1.02-1.08), respectively. CONCLUSION: Prolonged perioperative fasting, especially in the postoperative period, was observed in a sample of patients with gastric and colorectal cancer, and this was an independent predictor of LOS.

Perioperative Nutritional Management in Enhanced Recovery after Bariatric Surgery

“…As for PF, in elective surgery, a 12-h or overnight fasting protocol is commonly followed to minimize gastrointestinal and respiratory complications associated with anaesthesia. However, the literature broadly agrees that shorter fasting periods are beneficial [72].…”

“…In fact, the traditional idea is that feeding of patients after gastric resection should not be started until flatus or defecation have documented the return of bowel function. Conventionally, feeding patients after gastrointestinal surgery has been prescribed only after the return of peristalsis, and today clinicians still debate this topic, despite it having been shown that early feeding can be administered without risk and with potential benefits to patients [72].…”

Body mass index–based predictions and personalized clinical strategies for colorectal cancer in the context of PPPM

“…No data are available on the positive impact of IF without weight loss and the impact of changes in diet quality and physical activity patterns on the prognostic outcome of CRC [ 98 ]. It has been suggested that prolonged perioperative fasting in patients with CRC may lead to longer hospital stays [ 99 ]. The above studies suggest that IF can be used as an effective tool for patients with obesity and high BMI to reduce body fat and thus prevent CRC.…”