Preoperative Fasting Period Research Articles

The Effect of Prolonged Fasting Before Surgery on Pain and Anxiety

PurposeTo investigate the effect of prolonged fasting before surgery on pain and anxiety. DesignThis was a descriptive study. MethodsThis study was conducted in a plastic, reconstructive, and esthetic surgery clinic at a university hospital in Bursa, Turkey. A data collection tool was designed to collect data on the sociodemographic characteristics. The Beck Anxiety Scale was used to assess patients' anxiety in the preoperative period and the Visual Analog Scale was used to measure pain levels in the postoperative period. The Statistical Package for Social Sciences was used for data analysis. FindingsA total of 363 patients took part in the study. A majority (91.2%) of the patients who participated in the study were aware of why they were fasting before surgery, and 41.6% of them had been informed about preoperative fasting by the nurse. In addition, 60.9% of patients had thirst, 17.6% had headache, 40.5% were hungry, 62% had dry mouth, 79.6% were restless, and 83.7% were anxious. Most (82.6%) of the patients who participated in the study had a preoperative fasting period of more than 6 hours, 58.4% had a postoperative fasting period of 5 hours or less, and the mean fasting period was 6.82 ± 1.76. The mean score of the Visual Comparison Scale was 5.09 ± 0.31 and the mean score of the Beck Anxiety Scale was 21.86 ± 0.054, and patients with a fasting period of 6 hours or more experienced more pain and anxiety. ConclusionsThis study shows that patients with longer fasting duration experience more pain and anxiety, and patients with more anxiety experience more pain. Based on the results of this study, it is recommended that studies should be done to emphasize the issue and to increase the awareness of health care professionals about pre- and postoperative fasting.

Багатоцентрове опитування практикуючих лікарів Вінницької області щодо дотримання рекомендацій із передопераційного голодування та профілактики аспірації

Reducing the period of preoperative fasting is one of the most important principles of rapid metabolic optimization of patients within the concept of enhanced recovery after caesarean section (ERAS). Purpose - to analyze compliance by anesthesiologists with the recommendations of current protocols regarding preoperative fasting and prevention of aspiration in obstetric hospitals/departments of the city of Vinnytsia and the Vinnytsia region. Materials and methods. We conducted a multicenter survey in which 70 anesthesiologists from 21 medical institutions of Vinnytsia and Vinnytsia region, which provide assistance to obstetric patients, took part. Statistical data processing was carried out using the SPSS 21 program. Results. The results of our study show that most respondents (57.1%) recommend pregnant women to stop eating solid food 6-8 hours before cesarean section. It has been found that only 10% of anesthesiologists recommend to stop fluid intake as stated by current guidelines, i.e. 2 hours before surgery. According to the data obtained, the vast majority of respondents (85.8%) prescribe pharmacological prevention of aspiration during planned surgical interventions. Conclusions. The vast majority of anesthesiologists in Vinnytsia and Vinnytsia region follow the current recommendations of clinical guidelines regarding preoperative fasting and prevention of aspiration in obstetric patients. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Respondents informed consent was obtained for the study. No conflict of interests was declared by the authors.

Does the preoperative fasting period affect the liver in a distant organ model of renal ischaemia reperfusion?

To experimentally evaluate the effects of preoperative fasting duration on distant organ liver in renal ischaemia-reperfusion (IR) injury. This is an experimental study. In the study, 3 groups were formed. In Group A, abdominal laparotomy was carried out after 12 hours of preoperative fasting without any IR damage. In Group B, IR injury was carried out after 12 hours of preoperative fasting, and abdominal laparotomy was carried out, in Group C after 2 hours of fasting after IR injury. Apoptosis, congestion, balloon degeneration, nuclear pleomorphism, and leukocyte infiltration were examined histopathologically and tumor necrosis factor-alpha (TNF-α), interleukin (IL) -1 beta, IL-6, and IL-10 were evaluated biochemically. A statistically significant difference was determined between the groups in respect of postoperative IL-10 levels (p=0.020) with significantly lower levels determined in Group C than in Groups A and B (p=0.021). Similar rates of mild nuclear polymorphism were seen with no statistically significant difference determined between the groups (p>0.167). A statistically significant difference was determined between the groups in respect of the congestion scores (p<0.001), with a lower score in Group C than in Groups A and B, where the scores were similar (p<0.001, p=0.017). With this result, it would be correct to say that the short preoperative fasting period has protective effects on the liver tissue.

How long should the pre-operative fasting time be in patients with enteral tube nutrition?

Summary: The authors have touched a very important aspect of anesthesia and surgical practice, regarding the period of preoperative fasting for patients who are on enteral feeding. The authors recommend a fasting time between 45 min and 4 h (if the airway is to be manipulated during the procedure), is adequate to perform surgical procedures in patients with enteral tube nutrition. In other patients gastric suctioning before the procedure might be adequate.&#x0D; Key words: Adult; Elective Surgical Procedures; Enteral nutrition; Fasting; Humans; Intensive Care Units; Nutritional Status; Practice Guidelines as Topic; Preoperative Care / methods; Preoperative Period; Critical Illness / therapy; Patient Safety; Risk Management&#x0D; Citation: Useche LSV, Useche CV. How long should the pre-operative fasting time be in patients with enteral tube nutrition? Anaesth. pain intensive care 2022;26(4):576-577; DOI: 10.35975/apic.v26i4.1970__

Anxiolytic effects of chewing gum during preoperative fasting and patient-centered outcome in female patients undergoing elective gynecologic surgery: randomized controlled study

Although previous studies reported that chewing gum during the preoperative fasting has the benefits of alleviating anxiety and dry mouth, preoperative chewing gum has yet to be accepted as a standard practice due to conventional anesthetic custom. Our study aimed to prospectively evaluate the effects of gum chewing on preoperative anxiety and patient’s discomfort in female patients undergoing gynecologic surgery. Ninety-four patients were enrolled and randomized either into conventional fasting group (control group) or chewing gum with fasting group (gum group). The control group was instructed to fast from 3 p.m. on the day before surgery. The gum group performed preoperative fasting in the same manner, but was encouraged to chew gum freely during the fasting period. The primary endpoint was the degree of preoperative anxiety. For the evaluation of preoperative anxiety, Amsterdam preoperative anxiety and information scale (APAIS) was used. Preoperative gastric fluid volume and acidity were also measured as the secondary outcomes. Preoperative anxiety using APAIS was significantly lower in the gum group compared to the control group (control group vs. gum group: 20.9 vs. 17.8, p = 0.009). However, there was no significant difference in the gastric fluid analysis between the groups. In the female patients for elective gynecologic surgery, chewing gum during the preoperative fasting period helped to alleviate preoperative anxiety without additional increase of pulmonary aspiration risks.Trial registration: KCT0004422 (05/11/2019, https://cris.nih.go.kr; registration number).

Preoperative fasting: knowledge, attitude, and practice of postgraduate trainees at a tertiary care hospital\u2014an observational study

BackgroundLimiting the preoperative fasting period positively impact surgical patient outcome. In tertiary care hospitals, preoperative fasting instructions are mostly implemented by postgraduates. This study was conducted to evaluate the knowledge, attitude, and practice of postgraduate trainees of surgical specialties and anesthesiology regarding preoperative fasting. This observational study was conducted at a tertiary care hospital in May 2020. Consenting 166 postgraduate trainees of anesthesiology and surgical specialties was asked to respond to a questionnaire consisting of nine questions. The primary outcome was the knowledge status of postgraduate trainees regarding preoperative fasting guidelines and secondary outcomes being their attitude and practice of the same. Categorical data were presented as numbers and percentages.ResultsOut of 166 respondents, 149 (89.8%) and 94 (56.6%) respondents could not correctly describe the practice guidelines published by the American Society of Anaesthesiology pertaining to preoperative fasting in adult and pediatric patients respectively. Of the total respondents, 146 (87.9%) and 108 (65.1%) gave incorrect preoperative fasting instructions to adult and pediatric patients, respectively. The source of information regarding fasting guidelines was seniors amongst 89 (53.6%) respondents. Fifty-one (30.7%) respondents were unaware of the benefits of limiting preoperative fasting.ConclusionsThere is an imminent need for change in the knowledge, attitude, and practices of residents with regards to preoperative fasting practices. A holistic approach with formal teaching and development of SOP can achieve the change of practice of “NPO after midnight.”

THE INFLUENCE OF COMPLEX IMPLEMENTATION OF THE ERAS PROGRAM ON THE SURGICAL STRESS RESPONSE FACTORS IN PEDIATRIC PATIENTS UNDERGOING ELECTIVE LIMB SURGERY

Surgical stress response, fluid and nutritional balance, and pain management are among the key factors influencing on the postoperative period. These areas are reflected in the Enhanced Recovery After Surgery (ERAS) concept, which is based on a set of measures aimed at minimizing the surgical stress response. The lack of ERAS recommendations for the pediatric population of surgical patients prompts to search for a solution of adaptation and implementation of the ERAS programs in children. The aim of the study. To determine the effectiveness of the complex application of the enhanced recovery after surgery by studying its influence on the factors of the surgical stress response in pediatric patients undergoing limp surgery. Materials and methods. The prospective randomized study included 47 patients aged 1 to 17 years. In the study group (n = 22), the ERAS program was used, which consisted of 14 components of preoperative, intraoperative and postoperative measures. In the control group (n = 25), the complex of all ERAS components was not purposefully applied. We compared glycaemic stress index (GSI) and length of hospital stay after surgery (LOS) as a primary outcome; secondary outcomes were fasting time after drinking fluids before induction of anesthesia, estimated fluid deficiency just before induction of anesthesia, hemodynamic parameters, the need for opioids during and after surgery, blood glucose and beta-hydroxybutyrate in the beginning and in the end of the surgery and next day morning after surgery, postoperative nausea and vomiting. Results. GSI was significantly less in the study group (1,62 ± 0,78 vs 2,12 ± 0,93, р=0,046). LOS in the study group was 37.5% less than in the control group (p = 0.002). The period of preoperative fasting and fluid deficit in the patients of the study group were shorter. The needs of fentanyl intraoperatively in the study group was 47% less (p&lt;0.001). At the beginning of surgery, the study group had a higher blood glucose concentration and a higher systolic blood pressure. At the end of surgery, blood glucose and beta-hydroxybutyrate in the study group was lower than in the control group. In the postoperative period, 9% of patients in the study group and 36% of patients in the control group complained of nausea (p = 0.041). Linear regression analysis showed a linear relationship between the LOS after surgery and the GSI (R=0,515, R2=0,266, B=2,156, 95% CI 1,04 – 3,27, p&lt;0,001). Results. The implementation of the ERAS program to children 1-17 years old undergoing elective limp surgery may reduce the effect of the surgical stress reaction by reducing the period of preoperative fasting, fluid deficiency, the needs of opioids and postoperative nausea. Minimizing the surgical stress response may facilitate the achievement of hospital discharge criteria and shorten the length of hospital stay in the postoperative period.

Cardiac Enhanced Recovery After Surgery: Early Outcomes in a Community Setting

BackgroundEnhanced Recovery After Surgery (ERAS) programs have demonstrated improved outcomes in noncardiac surgery. More recently, ERAS has been applied to cardiac surgery with promising results. We have implemented cardiac ERAS at our community-based program, aiming to improve all phases of care, and now report our early results. MethodsWe retrospectively analyzed 73 consecutive patients treated with ERAS care compared with 74 patients treated before implementing ERAS. Our ERAS program consisted of 6 perioperative care bundles including enhanced patient education, shortened preoperative fasting period and oral carbohydrate load, postoperative nausea prophylaxis, multimodal opioid-sparing analgesia, early extubation, and early mobilization. ResultsERAS patients required significantly less opioids captured as total morphine milligram equivalents (MME) (median 35.0 vs 75.3; P < .001), less nausea as determined by fewer total ondansetron rescue doses (median 0 vs 0.5; P = .011), and less lightheadedness (P = .028) compared with pre-ERAS patients. Postoperative mobility was significantly better (postoperative day 4: 95% vs 81%; P = .013) and postoperative length of stay was lower for ERAS care but did not reach statistical significance (median 4 days vs 5 days; P = .06). There was no difference in pain or glucose control or in early extubation. ConclusionsCardiac ERAS significantly decreased opioid use, nausea, and lightheadedness and improved functional outcome for cardiac surgical patients in a community hospital.

ERAS: An Audit of Existing Practices.

Enhanced recovery after surgery (ERAS) is a set of multidisciplinary, evidence proven guidelines which enhance perioperative recovery in various surgical branches. This study was planned as a pilot effort with the aim of evaluating the surgical team's compliance to ERAS, in the absence of a structured programme, in the department of gynaecologic oncology of a tertiary care hospital in India. This is a retrospective audit of patients who underwent elective surgery, in the department of gynaecologic oncology, in a tertiary care centre in India, between 15th August 2019 to 15th October 2019. Emergency operations and those surgeries with palliative intent were excluded from the study. Electronic outpatient and inpatient records of patients chosen by convenient sampling were examined. Adherence to 18 components (pre-operative, intra-operative and post-operative) from the ERAS guidelines pertaining to surgical care were analysed. A total of 50 patients were included. Mean age group was 50years (22-76years). Majority of patients (60%) had a Charlson Deyo score of 0. Excellent compliance was noted with respect to preoperative counselling (94%), intraoperative management (86%) and post-operative factors such as early ambulation, thromboprophylaxis and early discharge. Practices which required improvement included reduction of period of pre-operative fasting, prehabilitation, carbohydrate loading, gum chewing and coffee consumption and early initiation of feeding in post-operative period. Dedicated and co-ordinated team effort will ensure that an ERAS protocol is enforced. Periodic auditing will reveal inconsistencies in compliance and guarantee benefit to patients.

The effect of preoperative fasting to postoperative agitation, nausea, and vomiting in children with tonsillectomy

Objective: This study was conducted to investigate the effect of preoperative fasting period on postoperative agitation, nause and vomiting in children with tonsillectomy.&#x0D; Material and Methods: Children (n:123) who have had tonsillectomy between June and December 2017 and their families have taken place in the study. The data were collected by the researchers with a questionnaire. The data were analyzed using the SPSS 18 package program and with descriptive, Mann Whitney U test, Spearman Correlation test.&#x0D; Results: The mean duration of preoperative fasting was 11.03±1.17 hours, the duration of thirst was 10.17±1.00 hours. The mean behavior scores of the children were 1.28±0.27 points, the mean vomiting score of the children was 0.01±0.07 points, 56.9% of the children in the postoperative unit were not experiencing nausea. Between duration of preoperative fasting with agitation and vomiting status in postoperative unit was found to statistically no relationship. According to preoperative fasting time of children, a statistically significant difference was found when children were diagnosed as having or not having symptoms of nausea.&#x0D; Conclusıon: It was found that the children had longer duration of preoperative fasting than the guidelines suggested in the guidelines. It was observed that pre-operative fasting time did not affect postoperative agitation and vomiting, but it affected nausea.&#x0D; Practice Implications: Surgical nurses should emphasize the importance of fasting period to families before surgery and inform families on this issue.&#x0D;

The Effects of Preoperative Sugarless Gum Chewing on Gastric Fluid Volume and pH

There is a lack of consensus regarding the preoperative fasting period on gum chewing due to conflicting evidence. Our study aimed to determine the effects of preoperative sugarless gum chewing on gastric fluid volume and pH. This prospective randomised study was performed on patients who underwent elective operation under general anaesthesia. Sixty patients who fasted overnight were randomly assigned to either “non-chewing gum” as control or “chewing gum group” as intervention group who chewed one piece of gum upon the call to the operating theatre. They were further enquired whether gum chewing helped cope with hunger and reduced anxiety. Gastric volume and pH were determined immediately after induction of anaesthesia. Gum chewing had no significant effect on gastric fluid volume measured [30.4+13.6 (control) vs 29.1+11.6 ml (intervention), p = 0.693] and gastric fluid pH [1.4+0.4 (control) vs 1.6+0.4 (intervention), p = 0.05] while managing to reduce anxiety in 90.3% patients who chewed gum. Pre-operative gum-chewing did not increase in gastric fluid volume or a further reduction in gastric fluid acidity and was able to reduce anxiety in patients in the preoperative period.

Restricted, optimized or liberal fluid strategy in thoracic surgery: A narrative review.

Perioperative fluid balance has a major impact on clinical and functional outcome, regardless of the type of interventions. In thoracic surgery, patients are more vulnerable to intravenous fluid overload and to develop acute respiratory distress syndrome and other complications. New insight has been gained on the mechanisms causing pulmonary complications and the role of the endothelial glycocalix layer to control fluid transfer from the intravascular to the interstitial spaces and to promote tissue blood flow. With the implementation of standardized processes of care, the preoperative fasting period has become shorter, surgical approaches are less invasive and patients are allowed to resume oral intake shortly after surgery. Intraoperatively, body fluid homeostasis and adequate tissue oxygen delivery can be achieved using a normovolemic therapy targeting a “near-zero fluid balance” or a goal-directed hemodynamic therapy to maximize stroke volume and oxygen delivery according to the Franck–Starling relationship. In both fluid strategies, the use of cardiovascular drugs is advocated to counteract the anesthetic-induced vasorelaxation and maintain arterial pressure whereas fluid intake is limited to avoid cumulative fluid balance exceeding 1 liter and body weight gain (~1-1.5 kg). Modern hemodynamic monitors provide valuable physiological parameters to assess patient volume responsiveness and circulatory flow while guiding fluid administration and cardiovascular drug therapy. Given the lack of randomized clinical trials, controversial debate still surrounds the issues of the optimal fluid strategy and the type of fluids (crystalloids versus colloids). To avoid the risk of lung hydrostatic or inflammatory edema and to enhance the postoperative recovery process, fluid administration should be prescribed as any drug, adapted to the patient's requirement and the context of thoracic intervention.

AB224. SOH21AS261. Preoperative fasting period among elective surgical patients at a tertiary level hospital, University Hospital Limerick (UHL)

Background: Preoperative fasting period is the prescribed time when oral intake of liquids or solids are restricted prior to surgical procedures either by general or regional anaesthesia, including sedation. The purpose of this obligatory fasting is to reduce the incidence of pulmonary aspiration of gastric contents secondary to the loss of airway reflexes. This potential consequence of anaesthesia has led to the universal adoption of preoperative fasting guidelines. The aim of this audit is to identify the duration of fasting and to investigate any cause of deviation from guidelines.

Pre-operative Hypoglycemia in Patients Presenting for Surgery: A Hospital Based Cross-sectional Study

Introduction: Peri-operative glycemic control is an important factor for post-operative recovery and is well protocoled for diabetic patients in every setup. It is not always so with non-diabetic patients. This study aimed to observe the pre-operative glucose level and prevalence of hypoglycemia in patients presenting for surgery and its association with the duration of nil per oral period (NPO), age and intravenous fluids used in the pre-operative period. Methods: A cross-sectional study was conducted in the Department of Anesthesiology in a Nepalese medical college including all the patients posted for elective surgery over a period of three months. Socio-demographic and clinical details of the participants were collected in the operating theatre. Duration of NPO period and intravenous fluid prescribed in the pre-operative fasting period were recorded. A glucose strip test was performed on all the participants. Results: Participants were found to have fasted for an unnecessarily longer duration (12.84±2.27 hours). The incidence of hypoglycemia in patients posted for elective surgery was very high (43.3%). Ringer lactate and normal saline were equally prescribed (38.4%) and dextrose-normal saline was prescribed in the rest of the participants. Gender and type of intravenous fluids were positively correlated whereas NPO period was negatively correlated in overall participants though statistically insignificant. In hypoglycemic participants, we observed that lower glucose was influenced by pre-operative fluids, age and NPO duration. Conclusion: Pre-operative use of glucose-containing fluids during NPO period is an important step to prevent hypoglycemia and related consequences.

Implementation of the Choosing Wisely Program in the General Surgery Residency

The practice of unnecessary conduct and waste in Health is an important topic, not often addressed during undergraduate training. Medical education has a fundamental role in student and doctors' training concerning cost-conscious attitudes for good health care. The aim of this study was to describe and assess the implementation of the Choosing Wisely campaign within a General Surgery residency program. This was an interventional study involving residency advisors and specialty residents. Recommendations based on three procedures frequently used in clinical practice, with no benefits and involving unnecessary risks for patients were identified by residency advisors with the use of the Delphi method and were grouped by frequency and by nature according to the Choosing Wisely layout. Educational actions such as workshops and banner advertising in addition to training activities regarding cost-conscious healthcare were carried out. This subject was also included in the theoretical evaluation of the residency program. The leading five recommendations were related to (i) computed tomography overuse (versus ultrasound imaging) in patients with suspected acute appendicitis, (ii) multithreaded computed tomography overuse in patients with low-risk trauma, (iii) longer than recommended antibiotic prophylaxis in surgical patients, (iv) longer than recommended preoperative fasting period and (v) upper gastrointestinal endoscopy overuse in surgical patients without an adequate clinical evidence or without the presence of warning signs. Awareness and reflection among participants were improved, leading to high grades in final evaluation. Changes in training regarding quality of care and cost awareness should start throughout undergraduate training, within a learning environment focused on a reflective and evidence-based practice. All the benefits and harms to patients were taken into account in the recommendations that emerged from this study. The inclusion of this initiative in the General Surgery residency, involving reflective discussions on campaign recommendations regarding procedures frequently used in clinical practice, with no benefits and involving unnecessary risks for patients may lead to more cost-conscious procedures.

An Analysis of Safety and Efficacy of Day-care Surgery in Children in a Tertiary Care Hospital in India.

Background:Advances in surgery and anesthesia have paved the way for the establishment of day-care surgery (DCS). Observations that children achieve better convalescence in the home environment along with significant economic advantages have led to this paradigm shift in clinical practice.Aims and Objectives:This study is aimed to evaluate the feasibility of performing various surgical procedures on day-care basis and assess parental satisfaction with DCS in children.Materials and Methods:In this prospective observational study, all children >3 months of age undergoing various elective surgical procedures as day-care cases in our institution were enrolled. Types of operations, complications, including any unplanned admissions and parental satisfaction, were recorded.Results:Between December 2015 and December 2018, a total of 654 day-care surgeries were performed in our institution by pediatric surgeons. The mean age was 5.5 years with M: F 5.5:1. Thirty different surgical procedures were successfully performed as DCS, the common procedures being inguinal herniotomy (31.5%), and orchidopexy (14.3%). Unplanned admissions were recorded in 2.29% (15/654) patients (scrotal edema-5, postoperative pain-8, and a long recovery from anesthesia-2). No major complications occurred; two minor complications during follow-up were superficial wound infection and drug reaction. Overall parental satisfaction was very high (100%)-preoperative prolonged fasting period and long waiting time in the preoperative room of afternoon shift patients (7.95% and 8.3%) were the reasons for their discontent.Conclusions:DCS in children is safe and effective with high parental satisfaction. It can substantially reduce the waiting list for several surgical procedures in children.

Interventions Aimed at Reducing Fasting Times in Acute Hospital Patients: A Systematic Literature Review.

Despite current guidelines recommending fasting from solids for ≤6 hours and clear fluids for ≤2 hours prior to surgery, outdated practices endure; patients fast for unnecessarily prolonged periods because of beliefs regarding aspiration risk upon anaesthesia induction. This literature review aimed to identify and evaluate current interventions aiming to reduce preoperative fasting times for acutely ill hospital patients, summarizing effective interventional strategies and associated outcomes. EMBASE, MEDLINE, PreMEDLINE, and CINAHL were systematically searched. Quality of evidence was assessed using Cochrane risk-of-bias tools. Studies, of any type, reporting fasting times as a primary or secondary outcome were included. A total of 1918 potential studies were identified; of these, 16 studies were included. Seven studies investigated the effect of changing fasting protocol on gastric fluid volume/residual gastric volume (GFV/RGV) and gastric pH as surrogate measures for aspiration risk. No significant differences in GFV/RGV and gastric pH due to reduced preoperative fasting were reported, thus no change in aspiration risk. Eight studies documented improvements in patient-reported outcomes with shorter fasting times. However, this review identified a paucity of studies that trialled interventions to reduce fasting times as the primary aim. These interventions were multimodal and multidisciplinary in nature, incorporating principles of implementation science to successfully achieve significant reductions in fasting times. This review highlights that reducing the preoperative fasting period is safe while improving patient's physical and psychological well-being. Further high-quality studies that investigate multimodal interventions, and that utilize implementation science principles, are required in this area.

Aplicação de protocolo de aceleração da recuperação pós-operatória em cirurgias de colectomia retossigmoidectomia, pancreatectomia e hepatectomia: experiência de hospital terciário

Introduction: Postoperative recovery of patients undergoing surgical procedures has been a focus of attention in recent years. Positive results from the Enhanced Recovery Based on the favorable results of the Enhanced Recovery After Surgery (ERAS) protocol, the ACERTO (Aceleração da Recuperação Total pós-operatória) protocol was designed in Brazil. This protocol defines some perioperative routines, such as nutritional therapy, decreased preoperative fasting period, early postoperative feeding, decreased venous hydration, among others, with favorable impact on postoperative recovery. The aim of this study was to compare the response of patients undergoing surgical procedures following or not a pilot protocol for accelerating postoperative recovery. Methods: A case-control study nested in a cross-sectional study reviewing medical records of patients hospitalized for colectomy, rectosigmoidectomy, pancreatectomy, and hepatectomy procedures between 2016 and 2017. The patients were divided into intervention and control group. Main endpoints analyzed were: length of postoperative hospital stay, hospitalization outcomes, rate of readmission within 30 days, and hospital costs. Results: 76 patients were enrolled (30 in intervention group and 46 in control group). The median length of in-hospital stay was 6.5 days for the intervention group and 13.5 days for the control group (p =0.0001). Rate of readmission within 30 days was 5.3 times lower in the intervention group in comparison to control group (p=0.02). Cost analysis showed a median per-patient cost of R$ 15.493,91 in the intervention group compared to a median per-patient cost of R$ 25.929,19 in the control group (p=0.0036). Conclusion: Patients who underwent the intervention of the postoperative recovery acceleration multimodal protocol presented shorter hospital stay, lower readmission rate at 30 days and lower hospital costs when compared to patients in the control group.

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Preoperative Fasting Times for Patients Undergoing Caesarean Delivery: Before and After a Patient Educational Initiative.

Prolonged preoperative fasting may lead to dehydration, hypoglycaemia, ketoacidosis and delayed recovery. We hypothesised that a patient educational initiative would decrease our preoperative fasting periods for elective caesarean delivery. This was an observational quality improvement impact study. Elective caesarean patients who delivered during our study period were included in the study, 40 patients in the pre-intervention and 40 patients in the post-intervention groups. Only English-speaking patients were included. We developed a patient educational pamphlet outlining preoperative fasting and analgesic expectations for caesarean delivery that was given to every patient at her preoperative anaesthesia consultation. The pamphlet included the American Society of Anesthesiologists' preoperative fasting and enhanced recovery carbohydrate drink recommendations. The primary outcome measure was intended fasting duration for liquids (defined as time from last reported liquid consumption to scheduled caesarean delivery) before and after the patient educational initiative. Secondary outcomes included solid fasting time, types of liquids and solids consumed. The intended median (interquartile range) fasting time for liquids decreased from 10 (8.9-12) h to 3.5 (2.5-10) h (p<0.001). The fasting period for solids was not significantly different: 12.5 (10.5-14) h pre- versus 12.4 (10.6-14) h post-pamphlet introduction (p=0.384). Despite the recommendation, only 22.5% consumed a carbohydrate-containing drink with a modest decrease in water consumption (87.5% before and 67.5% after; p=0.009). A patient educational pamphlet significantly reduced fasting time for clear liquids. Future studies are needed to determine what barriers limited adherence to the recommended carbohydrate-containing drink consumption.