Most patients start fasting too early preoperatively, consequently withholding food and oral fluids for longer than recommended, a University of Free State study found. As a result, the Universitas Hospital Annex, where the research took place, has modified its pre-surgery nutrition routine.
A team of medical students at the University of the Free State (UFS) that found that every patient having elective surgery at the Universitas Hospital Annex in Bloemfontein fasts for too long.
It’s a standard instruction if you’re having surgery in the morning: no food and drink after supper the night before. But it’s wrong. The Times reports that this is according to a team of medical students at the University of the Free State (UFS) that found that every patient having elective surgery at the Universitas Hospital Annex in Bloemfontein fasts for too long.
And it’s not just an academic point. “It is associated with problems‚ including increased pre-operative nausea and vomiting‚” they write. “Tissue repair is impaired by dehydration‚ and wound healing is improved when correct fluid fasting times are implemented.”
International guidelines say patients should abstain from food for six hours and from liquids for two hours before elective surgery. But, the report says, the UFS students‚ who investigated 105 patients‚ found that on average they abstained from foods and liquids for 10 hours. This was partly because of outdated advice from their doctors‚ and partly because they started fasting even earlier than doctors prescribed.
The students‚ supervised by Gillian Lamacraft‚ said the problem was exacerbated by fixed mealtimes at Universitas Hospital. “As a result of this study‚ the hospital will in future supply sandwiches for preoperative patients at 10pm the night before surgery and a carbohydrate-rich clear fluid drink at 5am on the day of surgery‚” they write.
“Such an approach has been proven to have no adverse effect on gastric volume or pH preoperatively compared with water or fasting from midnight. It has the positive effect of decreasing insulin resistance and increasing recovery of patients postoperatively.”
Background: Guidelines recommend a preoperative fasting period of 6 hours for solid food and 2 hours for clear fluids. Because of fixed meal times and imprecise operation starting times, patients often fast for an extended period of time.
Objective: To investigate the prescribed preoperative fasting times, and the actual duration of fasting, compared with the internationally accepted fasting times for solid food and clear fluids.
Methods: Patients (N=105) aged 14 – 60 years, who were scheduled for elective surgery in the morning session (list starting time 07h00), were included in this prospective study. On arrival in theatre, all patients were asked when they last ate and drank. Anaesthetic records were used to determine the prescribed fasting times and operation starting times.
Results: For solids, patients were most frequently prescribed to start fasting from 22h00 to 00h00 (53.3% and 39.1%, respectively). No patient fasted <8 hours. The median duration of fasting was 14 hours and 45 minutes (range 9 hours and 45 minutes – 19 hours and 5 minutes). For fluids, patients were most frequently prescribed to start fasting from 05h00 (46.7%), 00h00 (27.6%) and 22h00 (7.6%). In practice, no patient ingested fluids after 22h30 or <9 hours preoperatively. The median fasting time for oral fluids was 13 hours and 25 minutes (range 9 hours and 37 minutes – 19 hours and 5 minutes).
Conclusion: Most patients started fasting too early preoperatively, consequently withholding food and oral fluids for longer than recommended. An increased awareness regarding complications of unnecessarily long fasting times, and interventions to correct this problem, is required.
G Lamacraft, C Labuschagne, S Pretorius, M C Prinsloo, M D Smit, J-R Steyn
[link url="https://www.timeslive.co.za/news/south-africa/2017-10-01-not-so-fast-starving-yourself-hours-before-an-op-doesnt-help-say-ufs-medics/"]The Times report[/link]
[link url="http://www.samj.org.za/index.php/samj/article/view/12070"]South African Medical Journal abstract[/link]