Sidik Abubakar I, Lishchuk Alexandr, Faybushevich Alexander N, Moomin Aliu, Akambase Jonas, Dontsov Vladislav, Sobolev Dmitriy, Ilyas Mohammad Shafii Abdulmajid, Najneen Farjana, Ak Gulten, Ahlam Derrar, Adam Maridia K, Baatiema Linus, Benneh Charles, Adu-Gyamfi Paa Kofi T, Agyapong Frank, Mensah Kwesi Boadu
Surgery, Rossiiskii Universitet Druzhby Narodov (RUDN) University, Moscow, RUS.
Cardiothoracic Surgery, A.A. Vishnevskiy Third Central Military Clinical Hospital, Moscow, RUS.
Cureus. 2024 Oct 15;16(10):e71554. doi: 10.7759/cureus.71554. eCollection 2024 Oct.
Preoperative fasting is recommended by international guidelines as a means to minimize the risk of aspiration of gastric content during induction of anesthesia or surgery. Prolonged preoperative fasting is, however, discouraged due to the associated side effects such as dehydration and electrolyte imbalance, which can negatively impact recovery after surgery. An initial quality improvement study revealed poor implementation of the best practice guidelines on preoperative fasting in three departments of a hospital and an institutional action plan was devised to enforce adherence to these guidelines. This present study aimed to assess compliance with the action plan and for that matter, adherence to international consensus on preoperative fasting in three surgical departments.
Adult patients undergoing elective cardiac, thoracic, and vascular surgery at a university teaching hospital were surveyed over four months (September October, November, and December of 2023). Data on the length of preoperative fasting was collected using a standardized questionnaire. A total of 306 patients who were scheduled for elective surgery were included in the study.
Of the 306 patients, 139 (45.4%) had vascular surgeries, 108 (35.4%) received cardiac surgeries, and 59 (19.3%) had thoracic surgeries. For clear fluids, the overall median fasting time (Q1, Q3) was 4.5 (2.7, 7.4) hours, and for solid food, 14.5 (12.1, 19.0) hours. Extended abstinence from clear fluids and solid food for more than 12 hours was observed in 43 (14.1%) and 231 (75.5%) instances, respectively, while abstinence from solid food for more than 24 hours was noticed in 40 (13.1%) cases. When compared to patients having operations in the morning, those scheduled for afternoon surgery had longer median fasting periods from clear fluids and solid food, p<0.001: 6.2 (4.0, 12.0) hours vs. 3.4 (2.0, 5.2) hours for clear fluids and 16.7 (12.6, 22.6) hours vs. 13.2 (9.6, 15.2) hours for solid food, respectively.
Patients continue to abstain from clear fluids and solid food for extended periods of time, despite the fact that there is worldwide agreement regarding shorter periods of preoperative fasting. Compared to patients undergoing morning surgery, individuals hospitalized for afternoon procedures were more likely to fast for extended periods of time.
国际指南推荐术前禁食，作为在麻醉诱导或手术期间将胃内容物误吸风险降至最低的一种手段。然而，由于存在脱水和电解质失衡等相关副作用，不鼓励长时间术前禁食，这些副作用会对术后恢复产生负面影响。一项初步质量改进研究显示，一家医院的三个科室对术前禁食最佳实践指南的执行情况不佳，因此制定了一项机构行动计划以强制遵守这些指南。本研究旨在评估对该行动计划的依从性，以及三个外科科室对术前禁食国际共识的遵守情况。
在一所大学教学医院对接受择期心脏、胸科和血管手术的成年患者进行了为期四个月（2023年9月、10月、11月和12月）的调查。使用标准化问卷收集术前禁食时长的数据。共有306例计划进行择期手术的患者纳入本研究。
在306例患者中，139例（45.4%）接受了血管手术，108例（35.4%）接受了心脏手术，59例（19.3%）接受了胸科手术。对于清流食，总体禁食时间中位数（第一四分位数，第三四分位数）为4.5（2.7，7.4）小时，对于固体食物为14.5（12.1，19.0）小时。分别有43例（14.1%）和231例（75.5%）出现清流食和固体食物禁食时间超过12小时的情况，40例（13.1%）出现固体食物禁食时间超过24小时的情况。与上午进行手术的患者相比，安排在下午手术的患者清流食和固体食物的禁食时间中位数更长，p<0.001：清流食分别为6.2（4.0，12.0）小时和3.4（2.0，5.2）小时，固体食物分别为16.7（12.6，22.6）小时和13.2（9.6，15.2）小时。
尽管全球对于缩短术前禁食时间已达成共识，但患者仍长时间禁清流食和固体食物。与上午进行手术的患者相比，因下午手术住院的患者更有可能长时间禁食。
