Department of Nutrition, Physical Activity and Sports, Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands; Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia. Electronic address: https://twitter.com/Anne_Eskes.
Surgery. 2021 Aug;170(2):532-540. doi: 10.1016/j.surg.2021.01.037. Epub 2021 Mar 10.
Since 1999, international guidelines recommend fasting from solid foods up to 6 hours and clear liquids up to 2 hours before surgery. Early recovery after surgery programs recommend restoration of oral intake as soon as possible. This study determines adherence to these guidelines up to 20 years after its introduction.
A 2-center observational study with a 10-year interval was performed in the Netherlands. In period 1 (2009), preoperative fasting time was observed as primary outcome. In period 2 (2019), preoperative fasting and postoperative restoration of oral intake were observed. Fasting times were collected using an interview-assisted questionnaire.
During both periods, 311 patients were included from vascular, trauma, orthopedic, urological, oncological, gastrointestinal, and ear-nose-throat and maxillary surgical units. Duration of preoperative fasting was prolonged in 290 (90.3%) patients for solid foods and in 208 (67.8%) patients for clear liquids. Median duration of preoperative fasting from solid foods and clear liquids was respectively 2.5 and 3 times the recommended 6 and 2 hours, with no improvements from one period to another. Postoperative food intake was resumed within 4 hours in 30.7% of the patients. Median duration of perioperative fasting was 23:46 hours (interquartile range 20:00-30:30 hours) for solid foods and 11:00 hours (interquartile range 7:53-16:00 hours) for clear liquids.
Old habits die hard. Despite 20 years of fasting guidelines, surgical patients are still exposed erroneously to prolonged fasting in 2 hospitals. Patients should be encouraged to eat and drink until 6 and 2 hours, respectively, before surgery and to restart eating after surgery.
自 1999 年以来，国际指南建议手术前禁食固体食物 6 小时，禁食透明液体 2 小时。早期术后恢复计划建议尽快恢复口服摄入。本研究旨在确定这些指南在引入 20 年后的依从情况。
在荷兰的两个中心进行了一项为期 10 年的观察性研究。在第 1 期（2009 年），观察术前禁食时间作为主要结局。在第 2 期（2019 年），观察术前禁食和术后恢复口服摄入情况。使用访谈辅助问卷收集禁食时间。
在两个时期，分别从血管、创伤、骨科、泌尿科、肿瘤科、胃肠科、耳鼻喉科和上颌外科单位纳入 311 例患者。290 例（90.3%）患者固体食物和 208 例（67.8%）患者透明液体的术前禁食时间延长。术前禁食固体食物和透明液体的中位时间分别为推荐的 6 小时和 2 小时的 2.5 倍和 3 倍，且两个时期之间无改善。30.7%的患者术后 4 小时内恢复进食。固体食物的围手术期禁食中位时间为 23:46 小时（四分位距 20:00-30:30 小时），透明液体的禁食中位时间为 11:00 小时（四分位距 7:53-16:00 小时）。
旧习惯难改。尽管有 20 年的禁食指南，两家医院的手术患者仍错误地接受了长时间禁食。应鼓励患者分别在术前 6 小时和 2 小时进食和饮水，并在术后恢复进食。
