Incidence of excessive preoperative fasting: a prospective observational study

Editor—Preoperative fasting is a standard procedure before surgery that aims to prevent pulmonary aspiration. However, consequences of excessive preoperative fasting include dehydration, reduced patient comfort, increased postoperative insulin resistance, and increased catabolic response to surgery. 1 Brady M. Kinn S. Stuart P. Ness V. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003; 4: CD004423 PubMed Google Scholar ,2 Thorell A. Nygren J. Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care. 1999; 2: 69-78 Crossref PubMed Scopus (432) Google Scholar Current preoperative fasting guidelines advise that adults should fast 6 h for solids and 2 h for clear fluids, the 6–2 hour rule. 3 Smith I. Kranke P. Murat I. et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011; 28: 556-569 Crossref PubMed Scopus (594) Google Scholar ,4 Weimann A. Braga M. Carli F. et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017; 36: 623-650 Abstract Full Text Full Text PDF PubMed Scopus (1054) Google Scholar Children should fast 6 h for solids, 4 h for human milk, and 1 h for clear fluids (the 6–4–1 hour rule). 5 Thomas M. Morrison C. Newton R. Schindler E. Consensus statement on clear fluids fasting for elective pediatric general anesthesia. Paediatr Anaesth. 2018; 28: 411-414 Crossref PubMed Scopus (125) Google Scholar Moreover, intake should be encouraged up to these limits. 3 Smith I. Kranke P. Murat I. et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011; 28: 556-569 Crossref PubMed Scopus (594) Google Scholar ,5 Thomas M. Morrison C. Newton R. Schindler E. Consensus statement on clear fluids fasting for elective pediatric general anesthesia. Paediatr Anaesth. 2018; 28: 411-414 Crossref PubMed Scopus (125) Google Scholar Small cohort studies, mostly from surgical specialities, suggest that adherence to fasting guidelines is poor and excessive fasting seems the rule rather than the exception. 6 Crenshaw J.T. Winslow E.H. CE credit: original research: preoperative fasting: old habits die hard. Am J Nurs. 2002; 102: 36-45 Crossref PubMed Scopus (81) Google Scholar , 7 El-Sharkawy A.M. Daliya P. Lewis-Lloyd C. et al. Fasting and surgery timing (FaST) audit. Clin Nutr. 2021; 40: 1405-1412 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 8 van Noort H.H. Eskes A.M. Vermeulen H. et al. Fasting habits over a 10-year period: an observational study on adherence to preoperative fasting and postoperative restoration of oral intake in 2 Dutch hospitals. Surgery. 2021; 170: 532-540 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar We hypothesised that excessive preoperative fasting is still common practice. We aimed to assess the average preoperative fasting times for electively scheduled adult and paediatric surgical patients, and to identify risk factors influencing preoperative fasting.