Abstract
BackgroundGuidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture.MethodsIn a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77–97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45–71 and ten healthy volunteers, age 28–55.ResultsThe mean gastric half-emptying time in the elderly study group was 53 ± 5 (39–82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 ± 4 (41–106) and 59 ± 5 (33–72) minutes, indicating normal gastric emptying time in elderly with hip fracture.ConclusionThis pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.Trial registrationClinicalTrials.gov NCT02753010. Registered 17 April 2016, retrospectively.
Highlights
Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients
These patients are commonly kept fasting in preparation for surgery and may later even be reprioritized for surgery leading to further prolonged fasting time
Oral intake of 200 kcal carbohydrates triggers a release of insulin similar to that after a light meal [11], which should be positive from a nutritional perspective
Summary
Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture. The injury by itself, including the acute mental stress, are factors that theoretically can influence and delay gastric emptying. The patient suffers a risk of energy depletion, with consequent harmful effects on general health condition [10]. Preoperative carbohydrates provided in the form of a beverage have been shown to have several other benefits, such as reduced preoperative thirst, hunger and anxiety [14] All these positive properties of preoperative carbohydrate feeding instead of fasting should be considered in the medical care of elderly patients with a hip fracture
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