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El-Sharkawy AM, Daliya P, Lewis-Lloyd C, Adiamah A, Malcolm FL, Boyd-Carson H, Couch D, Herrod PJJ, Hossain T, Couch J, Sarmah PB, Sian TS, Lobo DN. Fasting and surgery timing (FaST) audit. Clin Nutr 2021; 40:1405-1412. [PMID: 32933783 PMCID: PMC7957363 DOI: 10.1016/j.clnu.2020.08.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS International guidance advocates the avoidance of prolonged preoperative fasting due to its negative impact on perioperative hydration. This study aimed to assess the adherence to these guidelines for fasting in patients undergoing elective and emergency surgery in the East Midlands region of the UK. METHODS This prospective audit was performed over a two-month period at five National Health Service (NHS) Trusts across the East Midlands region of the UK. Demographic data, admission and operative details, and length of preoperative fasting were collected on adult patients listed for emergency and elective surgery. RESULTS Of the 343 surgical patients included within the study, 50% (n = 172) were male, 78% (n = 266) had elective surgery and 22% (n = 77) underwent emergency surgery. Overall median fasting times (Q1, Q3) were 16.1 (13.0, 19.4) hours for food and 5.8 (3.5, 10.7) hours for clear fluids. Prolonged fasting >12 h was documented in 73% (n = 250) for food, and 21% (n = 71) for clear fluids. Median fasting times from clear fluids and food were longer in the those undergoing emergency surgery when compared with those undergoing elective surgery: 13.0 (6.4, 22.6) vs. 4.9 (3.3, 7.8) hours, and 22.0 (14.0, 37.4) vs. 15.6 (12.9, 17.8) hours respectively, p < 0.0001. CONCLUSIONS Despite international consensus on the duration of preoperative fasting, patients continue to fast from clear fluids and food for prolonged lengths of time. Patients admitted for emergency surgery were more likely to fast for longer than those having elective surgery.
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Affiliation(s)
- Ahmed M El-Sharkawy
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Prita Daliya
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Christopher Lewis-Lloyd
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Alfred Adiamah
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Francesca L Malcolm
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby, DE22 2QG, UK
| | - Hannah Boyd-Carson
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby, DE22 2QG, UK
| | - Daniel Couch
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby, DE22 2QG, UK
| | - Philip J J Herrod
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby, DE22 2QG, UK
| | - Tanvir Hossain
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Jennifer Couch
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Panchali B Sarmah
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Leicester Cancer Research Centre, University of Leicester, Leicester, LE2 7LX, UK
| | - Tanvir S Sian
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby, DE22 2QG, UK
| | - Dileep N Lobo
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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