Prevalence of Aspiration Risk due to a Full Stomach Assessed by Gastric Ultrasonography in Diabetic Patients Undergoing Non-Emergency Surgery

Abstract

Background: Pulmonary aspiration causes severe complications and high mortality, especially in diabetic patients during the perioperative period. Gastric ultrasonography is able to detect a patient with full stomach that poses high risk of pulmonary aspiration. However, in Thailand, there is no previous prevalence study. Objective: To study the prevalence of aspiration risk resulting from full stomach in diabetic patients during non-emergency surgery and to identify related risk factors using gastric ultrasonography. Materials and Methods: One hundred nineteen diabetic patients were enrolled between July 2021 and January 2022. A preoperative ultrasound examination of gastric content was performed in the right lateral decubitus position. Aspiration risk due to full stomach was defined as having solid contents or fluid volume more than 1.5 mL/kg. The associated risk factors were analyzed using multiple logistic regression models. Results: The prevalence of aspiration risk due to “full stomach” was 18.49% (22 out of 119 patients). Age between 65 and 84 years old (adjusted OR 015, 95% CI 0.04 to 0.54) and blood urea nitrogen (BUN) levels (adjusted OR 1.04, 95% CI 1.00 to 1.08) were statistically significantly associated risk factors (p<0.05). There was no incidence of pulmonary aspiration during the study period. Conclusion: While diabetic patients were advised to follow standard fasting guidelines, the risk of pulmonary aspiration persisted. Implementing an anesthetic plan as though the patient belonged to the “full stomach” group helped ensure the patient’s safety. Additionally, preoperative gastric ultrasound assessment is able to detect “full stomach” condition, thereby, further reducing the incidence of pulmonary aspiration.