Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study

Abstract

BackgroundProlonged fasting increases organic response to trauma. This multicenter study investigated the gap between the prescribed and the actual preoperative fasting times in Brazilian hospitals and factors associated with this gap.MethodsPatients (18–90-years-old) who underwent elective operations between August 2011 and September 2012 were included in the study. The actual and prescribed times for fasting were collected and correlated with sex, age, surgical disease (malignancies or benign disease), operation type, American Society of Anesthesiologists score, type of hospital (public or private), and nutritional status.ResultsA total of 3,715 patients (58.1% females) with a median age of 49 (18–94) years from 16 Brazilian hospitals entered the study. The median (range) preoperative fasting time was 12 (2–216) hours, and fasting time was longer (P<0.001) in hospitals using a traditional fasting protocol (13 [6–216] hours) than in others that had adopted new guidelines (8 [2–48] hours). Almost 80% (n=2,962) of the patients were operated on after 8 or more hours of fasting and 46.2% (n=1,718) after more than 12 hours. Prolonged fasting was not associated with physical score, age, sex, type of surgery, or type of hospital. Patients operated on due to a benign disease had an extended duration of preoperative fasting.ConclusionActual preoperative fasting time is significantly longer than prescribed fasting time in Brazilian hospitals. Most of these hospitals still adopt traditional rather than modern fasting guidelines. All patients are at risk of long periods of fasting, especially those in hospitals that follow traditional practices.

The use of mentholated popsicle to reduce thirst during preoperative fasting: A randomised controlled trial

“…The mean times of fasting for solid and liquids prior to a surgery were above the recommended by the ASA () and ERAS protocol (Gustafsson et al, ) in both groups, with approximately 8 hr above the recommended for liquids and 7 hr above the recommended for solids. These observations were similar to studies conducted in other countries (Abebe et al, ; Aguilar‐Nascimento et al, ; Francisco et al, ; Gul et al, ). Thirst in these patients is not only due to the duration of fasting, but can also be influenced by anxiety, medication type and age, for example (Arai et al, ; Conchon et al, ; Leiper, ).…”

“…There is evidence in the literature that surgical patients frequently fast for longer periods than necessary, both on the preoperative and postoperative periods (Abebe et al, 2016;Aguilar-Nascimento et al, 2014;Francisco et al, 2015;Gul et al, 2018;Tosun, Yava, & Açikel, 2015). This procedure negatively affects the surgical recovery and induces thirst in the patient (Abebe et al, 2016;ASA, 2017;Francisco et al, 2015;Gul et al, 2018).…”

Evaluating Gaps in Care of Malnourished Patients on General Medicine Floors in an Acute Care Setting

“…However, for a myriad of reasons including multiple procedures in 1 day or lack of communication to nutrition/food service staff, a patient may remain NPO for many hours longer than originally intended or clinically required. A large, multicenter study noted that patients may remain NPO for up to 24 hours, with a majority remaining NPO for >8 hours unintentionally . In a different meta‐analysis, it was shown that about 50% of the meals held for patients could have been served .…”

“…A large, multicenter study noted that patients may remain NPO for up to 24 hours, with a majority remaining NPO for >8 hours unintentionally. 17 In a different metaanalysis, it was shown that about 50% of the meals held for patients could have been served. 18 Such prolonged perioperative/periprocedure fasting has been shown to increase the risk for complications and is often unnecessary.…”

Cuidados perioperatórios em cirurgia bariátrica no contexto do projeto ACERTO: realidade e o imaginário de cirurgiões em um hospital de Cuiabá

“…It is believed that there is a mismatch between what one assumes to have prescribe and what is prescribed, that is, between the "real" and the "imaginary". The preoperative fasting time, for example, may be greater in audits than one might imagine from the medical prescription in Brazil 10 . Several factors may contribute to the fact that the recommended guidelines are not actually performed.…”