Audit of Preoperative Fasting for Elective General Surgeries in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

BACKGROUND

Despite overwhelming evidence in favour of a relaxed fasting protocol, the traditional practice of keeping patients nil per oral from midnight before the day of surgery for all elective operations still appears to hold sway in many practices.

METHODS

A prospective study to evaluate the pattern of preoperative fasting among patients undergoing elective general surgical operations in the Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was conducted between June and December 2020. Data obtained was analysed using the IBM SPSS Statistics for Windows, version 24, and presented as descriptive statistics in the form of frequencies and percentages.

RESULTS

The mean prescribed fasting duration was 11.2 ± 2.4 hours. The mean actual fasting duration of 17.6 ± 13.1 hours was significantly longer than the mean prescribed fasting duration (p= <0.001). Eighty-nine percent of patients fasted for >12 hours before their surgical operations. Bowel surgeries had the longest actual fasting duration of 34.9 ± 27.5 hours, while ventral hernia repairs and superficial mass excisions had the shortest duration of 13.5 ± 0.7 hours. Surgeries performed after noon had the longest actual fasting duration compared to those performed before noon (21.5 ± 18.7 hours vs. 15.6 ± 8.6 hours). Ninety percent of respondents reported hunger score of>4 while fasting.

CONCLUSION

Preoperative fasting duration in our surgical unit remains long and conventional. The potential implications of this practice on patients' physiological status and surgical outcomes are strong enough to motivate a change.

Nigerian resident doctors' work schedule: A national study

Background and Aim

The deleterious effects of Resident Doctors' (RDs') long duty hours are well documented. Driven by concerns over the physician's well-being and patient safety, the RDs' duty hours in many developed countries have been capped. However, in Nigeria and many African countries, there are no official regulations on work hours of RDs. This study evaluated the work schedule of Nigerian RDs and its impact on their wellbeing and patient safety.

Subjects and Methods

A national survey of 1105 Nigerian RDs from all specialties in 59 training institutions was conducted. With an electronic questionnaire designed using Google Forms, data on the work activities of RDs were obtained and analyzed using the IBM SPSS software version 24. The associations were compared using Chi-squared test with the level of significance set at < 0.05.

Results

The mean weekly duty hours (h) of the RDs was 106.5 ± 50.4. Surgical residents worked significantly longer hours than non-surgical residents (122.7 ± 34.2 h vs 100.0 ± 43.9 h; P < 0.001). The modal on-call frequency was two weekday on-calls per week (474, 42.9%) and two weekend on-calls per month (495, 44.8%), with the majority of RDs working continuously for up to 24 hours during weekday on-calls (854, 77.3%) and 48-72 hours during weekend on-calls (568, 51.4%), sleeping for an average of only four hours during these on-calls. The majority of RDs had post-call clinical responsibilities (975, 88.2%) and desired official regulation of duty hours (1,031, 93.3%).

Conclusion

The duty hours of Nigerian RDs are currently long and unregulated. There is an urgent need to regulate them for patient and physician safety.