Abstract
Introduction
Preoperative fasting is a time-tested professional practice that is undertaken for physiological and precautionary benefits to patients globally. Adherence to preoperative fasting guidelines is crucial for ensuring patient safety and minimizing complications during surgical procedures.
Objective
This study aimed to assess preoperative fasting times and factors affecting adherence to fasting guidelines among adult patients undergoing elective surgery at St. Paul’s Hospital Millennium Medical College.
Methods
A cross-sectional study involving 277 patients who underwent elective surgery at St. Paul Hospital Millennium Medical College was conducted. A stratified sampling technique was used to assign samples for each stratum (type of surgery), and a systematic random sampling technique was used to select participants from each stratum. Data on sociodemographic and clinical characteristics, preoperative fasting instructions, knowledge, and actual fasting times were collected via a structured questionnaire. Descriptive statistics and logistic regression analyses were performed to identify factors associated with adherence to fasting guidelines. Statistical significance of P < 0.25 for bivariate regression and P < 0.05 for multivariate regression were considered.
Results
Most patients fasted considerably longer than recommended, with mean fasting times of 9.76 ± 3.21 h for clear fluids, 10.84 ± 2.92 h for semisolids, and 11.92 ± 2.89 h for solids. Only 10.9 % of patients knew the importance of fasting before surgery, and 92.7 % did not receive information about why avoiding food and fluids was necessary. Factors significantly associated with poor adherence to fasting guidelines included being scheduled second or later for surgery (AOR: 5.199, 95 % CI: 1.412–19.143) and having no previous history of surgery (AOR: 8.746, 95 % CI: 2.462–31.072).
Conclusion
Prolonged preoperative fasting times and poor adherence to fasting guidelines were observed among the study participants. Patient education, standardized protocols, and multidisciplinary collaboration are recommended to improve adherence, enhance patient safety, and promote better anesthesia and surgical outcomes.
1
Introduction
Preoperative fasting is a time-tested professional practice that is undertaken for physiological and precautionary benefits to patients globally. Patients are deprived of certain and/or all foods and drinks for a specific duration before surgery . The importance of preoperative fasting was first recognized in the 19th century, following reports of pulmonary aspiration events and associated mortality during anesthetic procedures. In the mid-20th century, Dr. Curtis Mendelson’s seminal work highlighted the risks of regurgitation and aspiration of gastric contents during obstetric anesthesia, leading to the development of the first set of fasting guidelines.
The current guidelines for preoperative fasting are designed to balance the risk of pulmonary aspiration with patient comfort and well-being. The recommended fasting times vary depending on the type of intake. For elective surgical patients of all ages, a minimum of 2 h of fasting for clear liquids, 4 h for breast milk, and 6–8 h for nonhuman milk and solid foods is recommended before anesthesia requires general anesthesia, regional anesthesia, or procedural sedation and analgesia. ,
Examples of clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee. Because nonhuman milk is similar to solids in terms of gastric emptying time, the amount ingested must be considered when determining an appropriate fasting period. A light meal typically consists of toast and clear liquids. Meals that include fried or fatty foods or meat may prolong the gastric emptying time. Additional fasting time ( e. g . , 8 h or more) may be needed in these cases. Both the amount and type of food ingested must be considered when determining an appropriate fasting period
Although fasting is associated with adverse effects, a stomach that is as empty as possible is desirable before anesthesia to reduce the risk of passive regurgitation and pulmonary aspiration of stomach contents. A residual gastric volume of <1.5 ml kg has been deemed an acceptable volume for the baseline risk of aspiration. It is often assumed that fasting results in a low gastric residual stomach volume and that after a fast, with no stimulus for gastric acid production, the pH of any stomach fluid will be greater and therefore less irritable to the lungs in the event of aspiration. This practice of preoperative fasting plays a crucial role in ensuring patient safety and minimizing potential risks during surgical procedures. Fasting guidelines have been established to reduce the likelihood of pulmonary aspiration of gastric contents, a potentially life-threatening complication that can occur during the induction of anesthesia or in the postoperative period. However, there is substantial evidence that fasting does not reliably result in an empty stomach or fluid with higher pH.
Despite the well-established guidelines and recognized benefits of adherence, various studies have reported suboptimal compliance with preoperative fasting recommendations. ,
2
Methods and materials
2.1
Study setting
The study was conducted at St. Paul’s Hospital Millennium Medical College located in Addis Ababa, Ethiopia. St. Paul’s hospital Millennium Medical College, as it is known today, was established through a decree of the Council of Ministers in 2010, although the medical school opened in 2007 and the hospital was established in 1968 by the late Emperor Haile Selassie. The inpatient capacity is >700 beds, with an annual average of 300,000 patients. It has a catchment population of >5 million. The College sees an average of 1200 emergency and outpatient clients daily. St. Paul’s Hospital Millennium Medical College has 18 major functional operating rooms for elective surgery and 5 tables for emergency surgery, including orthopedic, urologic surgery, gynecology, pediatric, plastic, otolaryngology, maxillofacial, chest, general surgery and neurosurgery.
Currently, the Department of Anesthesiology, Critical Care, and Pain Medicine has 17 consultant anesthesiologists, 64 anesthesiology residents and 48 anesthetists.
2.2
Study design and period
A hospital-based cross-sectional study was conducted to assess preoperative fasting time and factors affecting adherence to preoperative fasting time among adult patients who underwent elective surgery at the SPHMMC from August 1, 2023, to September 30, 2023.
2.3
Study population
All elective adult patients were scheduled for elective surgery and fulfilled the inclusion criteria within the study period.
2.3.1
Inclusion criteria
- •
All patients 15 years old and above scheduled for elective surgery.
2.3.2
Exclusion criteria
- •
Patients who underwent emergency surgery, cesarean Section, minor surgery and pediatrics surgery.
- •
Patients who had cancelled from the surgery the day before surgery.
2.4
Sample size determination
The sample size calculation is based on a single population proportion formula in which the prevalence of preoperative fasting practice is 50 % with a 5 % margin of error at the 95 % confidence interval. Therefore, the sample size is calculated as
n=(Zα/2)2p(1−p)D2
=(1.96)2(0.5)*(0.5)/(0.05)2=384
The number of cases performed in the last 2 months in each table was as follows: orthopedics (90), general surgery (320), neurosurgery (50), cardiothoracic (32), urologic surgery (23), ENT and maxillofacial (150) and gynecology (100). A total of 764 cases were included since it was <SPAN role=presentation tabIndex=0 id=MathJax-Element-3-Frame class=MathJax style="POSITION: relative" data-mathml='<’><<
<
10,000 correctional formulas were used as follows:
NF=n(1+nN)
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