Abstract
BackgroundSince 1999, international guidelines recommend fasting from solid foods up to 6 hours and clear liquids up to 2 hours before surgery. Early recovery after surgery programs recommend restoration of oral intake as soon as possible. This study determines adherence to these guidelines up to 20 years after its introduction. MethodsA 2-center observational study with a 10-year interval was performed in the Netherlands. In period 1 (2009), preoperative fasting time was observed as primary outcome. In period 2 (2019), preoperative fasting and postoperative restoration of oral intake were observed. Fasting times were collected using an interview-assisted questionnaire. ResultsDuring both periods, 311 patients were included from vascular, trauma, orthopedic, urological, oncological, gastrointestinal, and ear-nose-throat and maxillary surgical units.Duration of preoperative fasting was prolonged in 290 (90.3%) patients for solid foods and in 208 (67.8%) patients for clear liquids. Median duration of preoperative fasting from solid foods and clear liquids was respectively 2.5 and 3 times the recommended 6 and 2 hours, with no improvements from one period to another. Postoperative food intake was resumed within 4 hours in 30.7% of the patients. Median duration of perioperative fasting was 23:46 hours (interquartile range 20:00–30:30 hours) for solid foods and 11:00 hours (interquartile range 7:53–16:00 hours) for clear liquids. ConclusionOld habits die hard. Despite 20 years of fasting guidelines, surgical patients are still exposed erroneously to prolonged fasting in 2 hospitals. Patients should be encouraged to eat and drink until 6 and 2 hours, respectively, before surgery and to restart eating after surgery.
Highlights
Twitter: @HarmvanNoort, @Anne_Eskes, @hvermeulen67, @MarcBesselink, @getty_huismanH.H.J. van Noort et al / Surgery 170 (2021) 532e540nutritional support for undernourished patients to meet individual nutrient requirements
Preoperative fasting from solids and liquids is mandatory to prevent gastric content causing pulmonary aspiration during anesthesia.6e8 Sufficient preoperative fasting behavior is defined as abstaining from solid foods for 6 hours and from clear liquids for 2 hours.[8,9]
Patients included during period 2 were 7.2 years older than patients in period 1
Summary
Twitter: @HarmvanNoort, @Anne_Eskes, @hvermeulen67, @MarcBesselink, @getty_huismanH.H.J. van Noort et al / Surgery 170 (2021) 532e540nutritional support for undernourished patients to meet individual nutrient requirements. Oral nutritional intake should be restored as soon as possible. Enhanced recovery after surgery (ERAS) programs incorporate nutritional recommendations and ensure improved recovery with less complications, shorter hospital stay, and lower hospital costs.[10] These recommendations include early restoration of oral intake,[1] preferably within 4 hours.[11]. Since 1999, international guidelines recommend fasting from solid foods up to 6 hours and clear liquids up to 2 hours before surgery. Recovery after surgery programs recommend restoration of oral intake as soon as possible. Methods: A 2-center observational study with a 10-year interval was performed in the Netherlands. In period 1 (2009), preoperative fasting time was observed as primary outcome. In period 2 (2019), preoperative fasting and postoperative restoration of oral intake were observed. Results: During both periods, 311 patients were included from vascular, trauma, orthopedic, urological, oncological, gastrointestinal, and ear-nose-throat and maxillary surgical units
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