Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China.
Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, 100035, China.
BMC Musculoskelet Disord. 2022 Jul 20;23(1):688. doi: 10.1186/s12891-022-05574-5.
Long-term fasting for elective surgery has been proven unnecessary based on established guidelines. Instead, preoperative carbohydrate loading 2 h before surgery and recommencing oral nutrition intake as soon as possible after surgery is recommended. This study was performed to analyze the compliance with and effect of abbreviated perioperative fasting management in patients undergoing surgical repair of fresh fractures based on current guidelines.
Patients with fresh fractures were retrospectively analyzed from the prospectively collected database about perioperative managements based on enhanced recovery of surgery (ERAS) from May 2019 to July 2019 at our hospital. A carbohydrate-enriched beverage was recommended up to 2 h before surgery for all surgical patients except those with contraindications. Postoperatively, oral clear liquids were allowed once the patients had regained full consciousness, and solid food was allowed 1 to 2 h later according to the patients' willingness. The perioperative fasting time was recorded and the patients' subjective comfort with respect to thirst and hunger was assessed using an interview-assisted questionnaire.
In total, 306 patients were enrolled in this study. The compliance rate of preoperative carbohydrate loading was 71.6%, and 93.5% of patients began ingestion of oral liquids within 2 h after surgery. The median (interquartile range) preoperative fasting time for liquids and solids was 8 (5.2-12.9) and 19 (15.7-22) hours, respectively. The median postoperative fasting time for liquids and solids was 1 (0.5-1.9) and 2.8 (2.2-3.5) hours, respectively. A total of 70.3% and 74.2% of patients reported no thirst and hunger during the perioperative period, respectively. Logistic regression analysis showed that the preoperative fasting time for liquids was an independent risk factor for perioperative hunger. No risk factor was identified for perioperative thirst. No adverse events such as aspiration pneumonia or gastroesophageal reflux were observed.
In this study of a real clinical practice setting, abbreviated perioperative fasting management was carried out with high compliance in patients with fresh fractures. The preoperative fasting time should be further shortened to further improve patients' subjective comfort.
基于既定指南，择期手术的长时间禁食已被证明是不必要的。相反，建议在手术前 2 小时给予碳水化合物负荷，并在手术后尽快恢复口服营养摄入。本研究旨在根据当前指南分析接受新鲜骨折手术修复的患者接受简化围手术期禁食管理的依从性和效果。
从 2019 年 5 月至 7 月我院基于手术加速康复（ERAS）的前瞻性收集的围手术期管理数据库中回顾性分析新鲜骨折患者。除禁忌证外，所有手术患者均建议在手术前 2 小时内饮用富含碳水化合物的饮料。术后，一旦患者恢复完全清醒，即可允许口服清亮液体，根据患者意愿，1 至 2 小时后可给予固体食物。记录围手术期禁食时间，并通过访谈辅助问卷评估患者对口渴和饥饿的主观舒适度。
共有 306 例患者纳入本研究。术前碳水化合物负荷的依从率为 71.6%，93.5%的患者在手术后 2 小时内开始摄入口服液体。液体和固体的中位（四分位间距）术前禁食时间分别为 8（5.2-12.9）和 19（15.7-22）小时。液体和固体的中位术后禁食时间分别为 1（0.5-1.9）和 2.8（2.2-3.5）小时。70.3%和 74.2%的患者分别报告在围手术期无口渴和饥饿感。Logistic 回归分析显示，液体的术前禁食时间是围手术期饥饿的独立危险因素。未发现围手术期口渴的危险因素。未观察到吸入性肺炎或胃食管反流等不良事件。
在这项真实临床实践环境下的研究中，新鲜骨折患者的简化围手术期禁食管理具有较高的依从性。术前禁食时间应进一步缩短，以进一步提高患者的主观舒适度。
