Assessment of adherence to preoperative fasting guidelines and associated patient discomfort in adult elective surgical patients in public hospitals of Addis Ababa, Ethiopia: a multicenter cross-sectional study

Abstract

Background: Preoperative fasting is compulsory before anesthesia to lower the risk of pulmonary aspiration. However, it is usually prolonged beyond the recommended time affecting the patient’s comfort and has several deleterious effects. Objective: To assess the adherence to preoperative fasting guidelines and associated patient discomfort in adult elective surgical patients in public hospitals of Addis Ababa, Ethiopia. Materials and methods: A multicenter cross-sectional study was conducted on 422 adult patients who underwent elective surgery at Addis Ababa public hospitals from February 20, to May 10, 2021. The collected data were entered into SPSS, version 24 for analysis. Spearman correlation and independent t test were used to assess the relationship between preoperative fasting time and explanatory variables, as appropriate. P value <0.05 was considered as statistically significant. Results: Majority (97.4%) of patients were instructed to fast from midnight regardless of the food type and schedule. Majority (98.1%) of the participants did not adhere to the preoperative fasting guidelines. The mean preoperative fasting time was 14.26±2.35 hours (range: 8–22 h) for solid foods and 13.89±2.37 hours (range: 8–21 h) for clear fluids. More than half (64%) of the participants felt preoperative discomfort, and factors contributing were thirst, hunger, mouth dryness, lengthy waiting of prior surgery, and tiredness. There was a moderate positive correlation between preoperative fasting time and severity of patient discomfort (P<0.001). There was also a strong positive correlation between total fasting time and the sequence of patient’s schedule (P<0.001). Conclusions: Preoperative fasting for solids and clear liquids was longer than the recommended international fasting guidelines. Preoperative fasting duration had an association with preoperative discomforting factors. Incorrect orders of instructions and changing sequences of schedule challenged the preoperative fasting adherence. Thus, preoperative fasting instructions should be clear, individualized; and health professionals need to communicate when surgery is delayed or changed.