Association of a liberal free fluid fasting policy before surgery with fasting duration and patient well-being and safety
Is implementation of a liberal clear liquid fasting policy before surgery associated with reduced duration of fasting and improved patient well-being and safety? This quality improvement study included 76,451 patients. After the implementation of the liberal fasting policy, the duration of fasting decreased. The results suggest that a liberal liquid fasting policy was successfully implemented. |
Importance
Current fasting guidelines for procedures under anesthesia are poorly implemented, leading to negative metabolic sequelae . Recent studies in children showed support for liberal intake of clear liquids; Adult physiology may support free fluid intake, but implementation studies are lacking.
Aim
To evaluate the success of implementing a liberal clear liquid policy with respect to fasting duration, well-being, and safety in adults scheduled for anesthesia.
Design, environment and participants
This was a quality improvement study conducted from January 2016 to July 2021 at a tertiary referral hospital in the Netherlands.
- Adults scheduled for non-emergency procedures under anesthesia were included in the study.
- Patients undergoing obstetric procedures or preoperatively intubated were excluded .
Interventions
Gradual introduction of a liberal fluid fasting policy, allowing the ingestion of clear fluids until arrival at the operating room.
Main results and measures
The primary outcome was the change in fasting duration. Secondary outcomes were patient well-being, measured as preoperative thirst, amount of fluid ingested, postoperative nausea and vomiting (PONV), and administration of antiemetics.
Safety was measured as incidence of regurgitation and aspiration (pneumonia).
Results
Of the 76,451 patients (mean [SD] age, 56 [17] years; 39,530 men [52%] 36,921) included in the study, 59,036 (78%) followed the standard policy and 16,815 (22%) followed the liberal policy .
Time series analysis showed an estimated decrease in fasting duration of 3:07 hours (IQR, 1:36-7:22; P < .001) after implementation of the liberal policy. The median post-deployment fasting duration (IQR) was 1:20 (0:48-2:24) hours.
The incidence of regurgitation changed from 18 (95% CI, 14-21) to 24 (95% CI, 17-32) in 10,000 patients, and the incidence of aspiration changed from 1.7 (95% CI, 0.6-32). 2.7) to 2.4 (95% CI, 0.5-4.7) in 10,000 patients.
In the liberal policy, the feeling of thirst decreased (37% [4982 of 8615] vs 46% [3373 of 7362]; p < .001).
The incidence of postoperative nausea and vomiting (PONV) decreased from 10.6% (6,339 of 59,636) to 9.4% (1,587 of 16,815; P < 0.001), and the administration of antiemetics decreased from 11.0% (6,538 of 59,636). ) at 9.5% (1592 of 16815; P < .001).
Conclusions and relevance
The 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 respect to preoperative thirst and PONV.
Although a slightly higher incidence of regurgitation cannot be ruled out , a broader implementation of such a policy can be recommended, as the results are still within clinically accepted risk margins.
The results suggest that surgical procedures in patients who drink free fluids within 2 hours before anticipated anesthesia should not be postponed or canceled .
