Perioperative medicine & outcomes
Association of a Liberal Fasting Policy of Clear Fluids Before Surgery With Fasting Duration and Patient Well-being and Safety
Authors' conclusion
Results of this quality improvement study suggest that a liberal fasting policy was associated with a clinically relevant reduction in fasting duration and improved patient well-being with regard to preoperative thirst and PONV.
Study context
- Population
- Adults scheduled for nonemergency procedures under anesthesia at a tertiary referral hospital in the Netherlands, 2016–2021; obstetric or preoperatively intubated patients excluded
- Participants
- 76,451 adults
- Comparison
- Liberal clear fluid fasting policy vs standard fasting policy
- Liberal policyn = 16,815
- Standard policyn = 59,036reference
- Outcome
- Change in fasting duration
Methodological detailstime series analysis, single-centre tertiary referral hospital, Stepwise introduction of the liberal policy, January 2016 to July 2021
- Time series analysis
- Single-centre tertiary referral hospital
- Stepwise introduction of the liberal policy, January 2016 to July 2021
Main finding
As reported in the abstract
Estimated fasting duration decrease after implementation of the liberal policy (time series analysis), hours (IQR, 1:36-7:22; P < .001)
3:07
Postimplementation median fasting duration, hours (IQR 0:48-2:24)
1:20
Secondary outcomes
Preoperative thirst
- Thirst feelings in the liberal policy (4982 of 8615), decreased vs 46% (3373 of 7362); P < .001
- 37%
Postoperative nausea and vomiting (PONV)
- PONV incidence decreased from 10.6% (6339 of 59 636) to 9.4% (1587 of 16 815); P < .001
Antiemetic administration
- Antiemetic administration decreased from 11.0% (6538 of 59 636) to 9.5% (1592 of 16 815); P < .001
Safety
Regurgitation (per 10 000 patients)
- Incidence of regurgitation changed from 18 (95% CI, 14-21) to 24 (95% CI, 17-32) in 10 000 patients
- Slightly higher incidence could not be ruled out
Aspiration (per 10 000 patients)
- Incidence of aspiration changed from 1.7 (95% CI, 0.6-2.7) to 2.4 (95% CI, 0.5-4.7) in 10 000 patients
Original publication
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