Cross-Sectional Study of the Efficacy of Preoperative Fasting Guidelines on Postoperative Recovery and Complications in General Surgery
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https://doi.org/10.63682/jns.v13i1.8590Keywords:
N\AAbstract
Background: Traditional preoperative fasting protocols often result in prolonged fasting periods that exceed recommended guidelines. This cross-sectional study aimed to evaluate the relationship between adherence to modern preoperative fasting guidelines and postoperative outcomes in patients undergoing elective general surgery procedures.
Methods: We conducted a prospective cross-sectional study of 240 adult patients undergoing elective general surgical procedures between January 2023 and April 2024. Patients were categorized based on their actual fasting durations as either adherent or non-adherent to current guidelines (≤6 hours for solids, ≤2 hours for clear liquids). Primary outcomes included postoperative nausea and vomiting (PONV), thirst, hunger, insulin resistance (measured by HOMA-IR), and surgical site infections. Secondary outcomes included length of hospital stay and patient comfort scores. Multiple logistic regression analysis was used to identify associations between fasting duration and outcomes while controlling for confounding variables.
Results: The median preoperative fasting time was 13.7 hours (IQR: 10.2-16.4) for solids and 9.2 hours (IQR: 7.1-12.5) for clear liquids, with only 18.3% of patients adhering to recommended fasting guidelines. Patients with prolonged fasting (>12 hours) had significantly higher rates of PONV (42.7% vs. 23.1%, p=0.003), greater postoperative insulin resistance (mean HOMA-IR difference: 1.24, 95% CI: 0.78-1.70, p<0.001), and higher thirst scores (mean difference: 2.7 points on 10-point scale, p<0.001). After adjusting for confounding variables, prolonged fasting remained independently associated with increased PONV (adjusted OR: 2.46, 95% CI: 1.38-4.39) and insulin resistance (β=0.98, 95% CI: 0.52-1.44).
Conclusion: Adherence to modern preoperative fasting guidelines was poor in our study population. Prolonged fasting was independently associated with increased postoperative complications including PONV and insulin resistance. Implementation strategies to improve adherence to evidence-based fasting protocols may improve patient outcomes after general surgery
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