Preoperative Fasting Guidelines: Where Are We Now? Findings From Current Practices in a Tertiary Hospital

Zhu, Qianqian; Li, Yamei; Deng, Yingqing; Chen, Jiaxin; Zhao, Shuhua; Bao, Kaibei; Lai, Lifei

doi:10.1016/j.jopan.2020.09.002

Cited by 9 publications

(16 citation statements)

References 15 publications

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“…Second, the patients were more conservative than the clinical staff. Similar to preoperative fasting, which lasted longer than the durations instructed by clinical staff from our previous observation, 27 patients' actual postoperative fasting time was also longer than that instructed by clinical staff. The reason for the conservative nature of the patients also needs to be elucidated in future studies.…”

Section: Discussionsupporting

confidence: 56%

“…In line with the preoperative fasting in our previous study, the patients might always be conservative. 27 Notably, in the present study, patients initiated oral intake before the passage of flatus or stool, and no serious ileus occurred.…”

Section: Discussionmentioning

confidence: 52%

“… 3 20 22 However, the gap between clinical practice and evidence is common. 7 31 Patients scheduled for surgery usually undergo a much longer preoperative fasting than the evidence-based guidelines recommend, 27 and most patients still have to endure long postoperative fasting. In the present study, the ward staff always instructed the patients to initiate oral feeding 6 hours after surgery.…”

Section: Discussionmentioning

confidence: 99%

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Current practice of postoperative fasting: results from a multicentre survey in China

et al. 2022

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ObjectiveA gap between clinical practice and evidence is common. The present multicentre study was designed to explore the actual postoperative fasting practice, including the instructed fasting time from the ward staff and the actual postoperative fasting time.DesignMulticentre survey.SettingFour tertiary hospitals in Shenzhen City, China.ParticipantsA total of 988 patients completed a survey on instructed and actual postoperative fasting.OutcomesAll patients received postoperative instructed fasting time from the ward staff. The median instructed fasting time for fluids from ward staff was 6 hours (IQR, 4–6 hours), and the median instructed fasting time for solid food was also 6 hours (IQR 5–6 hours) after surgery. The actual postoperative fasting time, including fluid and solid food intake, was significantly longer than the time recommended by the ward staff (both p<0.001).ResultsThe median time to postoperative first flatus (FFL) was 16.5 hours (IQR 8–25.5 hours), and the median time to postoperative first faeces (FFE) was 41 hours (IQR 25–57 hours). The fasting time was significantly shorter than the time to FFL and the time to FFE, regardless of surgery type or anaesthesia type (all p<0.001). Postoperative nausea and vomiting (PONV) occurred in 23.6% of patients. After surgery, 58.70% of patients reported thirst, and 47.47% reported hunger. No ileus occurred.ConclusionApproximately half of the patients reported thirst and hunger postoperatively. Patients initiated oral intake earlier than the time to FFL or FFE without increasing serious complications. This study may support the rationale for interventions targeting postoperative oral intake time in future studies.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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Current practice of postoperative fasting: results from a multicentre survey in China

et al. 2022

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“…Second, some patients initiated their first oral intake later than immediately after discharge from the PACU. This was consistent with a previous study reporting that patients fasted longer than medical staff recommended preoperatively 27 . The reasons why patients were more ‘conservative' than the medical staff need to be explored in future studies.…”

Section: Discussionsupporting

confidence: 90%

“…This was consistent with a previous study reporting that patients fasted longer than medical staff recommended preoperatively. 27 The reasons why patients were more 'conservative' than the medical staff need to be explored in future studies. To explore the effect of an actual early regular diet for no more than 6 h, we performed subgroup analyses.…”

Section: Discussionmentioning

confidence: 99%

Effects of liberal oral intake on postoperative outcomes after elective laparoscopic gynaecological surgery: A randomised controlled clinical trial

Bao

Deng

Zhao

et al. 2022

J Human Nutrition Diet

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Background Women are at risk of postoperative nausea and vomiting (PONV) after laparoscopic gynaecological surgery. Traditionally, patients who undergo laparoscopic gynaecological surgery are only allowed to initiate oral intake after return of bowel function, including bowel sounds or passage of flatus or stool. The present study was designed to assess the effect of liberal oral intake immediately after discharge from the post‐anaesthesia care unit (PACU) on PONV incidence in patients who underwent elective laparoscopic gynaecological surgery. Methods In total, 174 patients (aged 20–64 years) were randomly assigned to the traditional and liberal groups. In the traditional group, patients were allowed to initiate oral intake 6 h after discharge from the PACU. In the liberal group, patients were allowed oral intake immediately after discharge from the PACU. The primary outcome was the incidence of PONV 48 h after surgery. Secondary outcomes included ileus incidence, total dose of postoperative opiate (sufentanil) use, time to postoperative first flatus (FFL), first out‐of‐bed mobilisation and the duration of postoperative hospitalisation stay. Results Incidence of PONV was not significantly different between both groups (32.18% vs. 33.33%, p = 0.872). Time to FFL in the liberal group was significantly shorter than that in the traditional group (14.82 ± 0.91 h vs. 17.50 ± 0.96 h, p = 0.024). The postoperative pain score at 48 h after surgery was significantly lower in the liberal group than that in the traditional group (2.48 ± 0.17 vs. 3.20 ± 0.19, p = 0.008) without an increase in sufentanil use (89.32 ± 1.02 µg vs. 89.92 ± 1.16 µg, p = 0.702). No ileus occurred in either group. When considering the time of actually return to regular diet, initiating regular diet no more than 6 h after discharge from PACU significantly shortened the time to first out‐of‐bed mobilisation (11.18 ± 1.01 h vs. 15.05 ± 0.70 h, p = 0.003). Conclusions Our results indicate that liberal oral intake after discharge from the PACU in patients aged 20–64 years who underwent gynaecological surgery is safe and beneficial and supports the rationale for a more liberal diet regime postoperatively.

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

et al. 2023

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ImportanceCurrent fasting guidelines for procedures under anesthesia are poorly implemented, leading to negative metabolic sequelae. Recent studies in children showed support of liberal clear fluid intake; adult physiology can support clear fluid intake, but implementation studies are lacking.ObjectiveTo evaluate the successfulness of implementation of a liberal clear fluid policy with regard to fasting duration, well-being, and safety in adults scheduled for anesthesia.Design, Setting, and ParticipantsThis was a quality improvement study conducted from January 2016 to July 2021 at a tertiary referral hospital in the Netherlands. Adults scheduled for nonemergency procedures under anesthesia were included in the study. Patients undergoing obstetrics procedures or those who were intubated preoperatively were excluded.InterventionsStepwise introduction of a liberal fluid fasting policy, allowing for ingestion of clear fluids until arrival at the operating room.Main Outcomes and MeasuresThe primary outcome was change in fasting duration. Secondary outcomes were patient well-being, measured as preoperative thirst, amount of fluid ingested, postoperative nausea and vomiting (PONV), and administration of antiemetics. Safety was measured as incidence of regurgitation and aspiration (pneumonia).ResultsOf the 76 451 patients (mean [SD] age, 56 [17] years; 39 530 male individuals [52%] 36 921) included in the study, 59 036 (78%) followed the standard policy, and 16 815 (22%) followed the liberal policy. Time series analysis showed an estimated fasting duration decrease of 3:07 hours (IQR, 1:36-7:22; P &lt; .001) after implementation of the liberal policy. Postimplementation median (IQR) fasting duration was 1:20 (0:48-2:24) hours. The incidence of regurgitation changed from 18 (95% CI, 14-21) to 24 (95% CI, 17-32) in 10 000 patients, and the incidence of aspiration changed from 1.7 (95% CI, 0.6-2.7) to 2.4 (95% CI, 0.5-4.7) in 10 000 patients. In the liberal policy, thirst feelings decreased (37% [4982 of 8615] vs 46% [3373 of 7362]; P &lt; .001). PONV incidence decreased from 10.6% (6339 of 59 636) to 9.4% (1587 of 16 815; P &lt; .001) and antiemetic administration decreased from 11.0% (6538 of 59 636) to 9.5% (1592 of 16 815; P &lt; .001).Conclusions and RelevanceResults of this quality improvement study suggest that a liberal fasting policy was associated with a clinically relevant reduction in fasting duration and improved patient well-being with regard to preoperative thirst and PONV. Although a slightly higher incidence of regurgitation could not be ruled out, wider implementation of such a policy may be advocated as results are still within the clinically accepted risks margins. Results suggest that surgical procedures in patients who drink clear fluids within 2 hours before anticipated anesthesia should not be postponed or canceled.

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Preoperative Fasting Guidelines: Where Are We Now? Findings From Current Practices in a Tertiary Hospital

Cited by 9 publications

References 15 publications

Current practice of postoperative fasting: results from a multicentre survey in China

Current practice of postoperative fasting: results from a multicentre survey in China

Effects of liberal oral intake on postoperative outcomes after elective laparoscopic gynaecological surgery: A randomised controlled clinical trial

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

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