Real-World Evidence: How Long Do Our Patients Fast?—Results from a Prospective JAGO-NOGGO-Multicenter Analysis on Perioperative Fasting in 924 Patients with Malignant and Benign Gynecological Diseases

Abstract

Background: Despite the key role of optimized fasting in modern perioperative patient management, little current data exist on perioperative fasting intervals in routine clinical practice. Methods: In this multicenter prospective study, the length of pre- and postoperative fasting intervals was assessed with the use of a specifically developed questionnaire. Between 15 January 2021 and 31 May 2022, 924 gynecology patients were included, from 13 German gynecology departments. Results: On average, patients remained fasting for about three times as long as recommended for solid foods (17:02 ± 06:54 h) and about five times as long as recommended for clear fluids (9:21 ± 5:48 h). The average perioperative fasting interval exceeded one day (28:23 ± 14:02 h). Longer fasting intervals were observed before and after oncological or extensive procedures, while shorter preoperative fasting intervals were reported in the participating university hospitals. Smoking, treatment in a non-university hospital, an increased Charlson Comorbidity Index and extensive surgery were significant predictors of longer preoperative fasting from solid foods. In general, prolonged preoperative fasting was tolerated well and quality of patient information was perceived as good. Conclusion: Perioperative fasting intervals were drastically prolonged in this cohort of 924 gynecology patients. Our data indicate the need for better patient education about perioperative fasting.

Morning or Afternoon Scheduling for Elective Coronary Artery Bypass Surgery: Influence of Longer Fasting Periods from Metabolic and Hemodynamic Perspectives

“…However, in real-world practice at institutions where such ERAS programs are not running, patients scheduled for elective surgery are usually fasted for at least 6 to 8 h preoperatively to lower the risks of pulmonary aspiration during anesthesia induction. [ 8 ] Further, several studies have demonstrated that the real-world fasting duration is much longer and approaches or even exceeds 12 h.[ 9 10 ] For instance, a study in older adults undergoing elective surgery under spinal anesthesia demonstrated that fasting times are far longer than recommended, and are significantly higher in cases scheduled in the afternoon (12.7 and 15.5 h for liquids and food, respectively) as compared to morning ones (9.5 and 12 h, respectively). Notably, afternoon cases showed more frequent electrocardiogram changes and lower body temperature.…”