The Clinical Effect and Safety of New Preoperative Fasting Time Guidelines for Elective Surgery: a Systematic Review and Meta-analysis

Overview

Journal Gland Surg

Publisher AME Publishing Company

Specialty Endocrinology

Date 2022 Apr 11

PMID 35402209

Authors

Yuying He

Rongrong Wang

Fei Wang

Lili Chen

Tingting Shang

Luya Zheng

Affiliations

Soon will be listed here.

Abstract

Background: Traditional fasting and no drinking schemes (fasting for 8-12 hours and no drinking for 4-6 hours) affect the metabolism of the body. The new guidelines put forward by the American Association of Anesthesiologists (fasting for 6 hours, no drinking for 2 hours) obviously reduce the time of fasting and no drinking, but the clinical efficacy and safety need to be further confirmed. In this study, a meta-analysis of randomized controlled trials (RCTs) using the new guidelines and traditional protocols was conducted to provide an evidence-based foundation for elective surgery.

Methods: The articles were searched in PubMed, EBSCO, MEDLINE, Science Direct, Cochrane Library, CNKI, China Biomedical Resources Database, Wanfang Database, Weipu, and Western Biomedical Journal Literature Database. RCTs related to fasting before surgery during the screening period were selected. Chinese and English search keywords included elective surgery, preoperative, fasting and no drinking, patient comfort, thirst, hunger, collapse, hypoglycemia, preoperative gastric volume, preoperative gastric juice pH, and intraoperative gastric volume. The RevMan 5.3 software provided by Cochrane collaboration network was used to evaluate the quality of included documents. Two professionals independently screened the literature, extracted data, and assessed the risk of bias.

Results: A total of 6 studies were included. The incidence of hunger in patients undergoing elective surgery in the experimental group and control group was significantly different [Z=3.90; relative risk (RR) =0.58; 95% confidence interval (CI): 0.44, 0.76; P<0.0001]. The incidence of thirst was significantly different between the experimental group and control group (Z=7.22; RR =0.21; 95% CI: 0.13, 0.32; P<0.00001).

Discussion: Meta-analysis results confirmed that the new guidelines can significantly reduce the hunger and thirst of patients, improve their satisfaction after surgery, and can be applied clinically.

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References

Yildiz H, Gunal S, Yilmaz G, Yucel S . Oral carbohydrate supplementation reduces preoperative discomfort in laparoscopic cholecystectomy. J Invest Surg. 2013; 26(2):89-95. DOI: 10.3109/08941939.2012.699998. View

Habermann E . Are Opioids Overprescribed Following Elective Surgery?. Adv Surg. 2018; 52(1):247-256. DOI: 10.1016/j.yasu.2018.03.003. View

Gustafsson U, Scott M, Schwenk W, Demartines N, Roulin D, Francis N . Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(®)) Society recommendations. World J Surg. 2012; 37(2):259-84. DOI: 10.1007/s00268-012-1772-0. View

Sparreboom C, Lambrichts D, Menon A, Kleinrensink G, Lingsma H, Lange J . Outcomes After Elective Colorectal Surgery by 2 Surgeons Versus 1 Surgeon in a Low-Volume Hospital. Surg Innov. 2019; 26(6):753-759. DOI: 10.1177/1553350619868109. View

Dwyer T, Henry P, Cholvisudhi P, Chan V, Theodoropoulos J, Brull R . Neurological Complications Related to Elective Orthopedic Surgery: Part 1: Common Shoulder and Elbow Procedures. Reg Anesth Pain Med. 2015; 40(5):431-42. DOI: 10.1097/AAP.0000000000000178. View

Biondi A, Santullo F, Fico V, Persiani R . Long-term Outcomes of Elective Surgery for Diverticular Disease: A Call for Standardization. J Clin Gastroenterol. 2016; 50 Suppl 1:S77-9. DOI: 10.1097/MCG.0000000000000599. View

Carmichael H, Moore A, Steward L, Velopulos C . Disparities in Emergency Versus Elective Surgery: Comparing Measures of Neighborhood Social Vulnerability. J Surg Res. 2020; 256:397-403. DOI: 10.1016/j.jss.2020.07.002. View

Feuerstein J, Curran T, Alosilla M, Cataldo T, Falchuk K, Poylin V . Mortality Is Rare Following Elective and Non-elective Surgery for Ulcerative Colitis, but Mild Postoperative Complications Are Common. Dig Dis Sci. 2018; 63(3):713-722. DOI: 10.1007/s10620-018-4922-x. View

Alverdy J, Hyman N, Gilbert J . Re-examining causes of surgical site infections following elective surgery in the era of asepsis. Lancet Infect Dis. 2020; 20(3):e38-e43. PMC: 8019154. DOI: 10.1016/S1473-3099(19)30756-X. View

10.

Asaf Khan R, Hajibandeh S, Hajibandeh S . Early elective versus delayed elective surgery in acute recurrent diverticulitis: A systematic review and meta-analysis. Int J Surg. 2017; 46:92-101. DOI: 10.1016/j.ijsu.2017.08.583. View

11.

Turunen E, Miettinen M, Setala L, Vehvilainen-Julkunen K . Elective Surgery Cancellations During the Time Between Scheduling and Operation. J Perianesth Nurs. 2018; 34(1):97-107. DOI: 10.1016/j.jopan.2017.09.014. View

12.

Singh M, Chaudhary M, Vashistha A, Kaur G . Evaluation of effects of a preoperative 2-hour fast with glutamine and carbohydrate rich drink on insulin resistance in maxillofacial surgery. J Oral Biol Craniofac Res. 2015; 5(1):34-9. PMC: 4382506. DOI: 10.1016/j.jobcr.2015.02.006. View

13.

Dias J, Sauaia A, Achneck H, Hartmann J, Moore E . Thromboelastography-guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis. J Thromb Haemost. 2019; 17(6):984-994. PMC: 6852204. DOI: 10.1111/jth.14447. View

14.

Napolitano M, Sparks A, Randall J, Brody F, Duncan J . Elective surgery for diverticular disease in U.S. veterans: A VASQIP study of national trends and outcomes from 2004 to 2018. Am J Surg. 2020; 221(5):1042-1049. DOI: 10.1016/j.amjsurg.2020.08.050. View

15.

Brown C, Albright J, Henke P, Mansour M, Weaver M, Osborne N . Modeling the elective vascular surgery recovery after coronavirus disease 2019: Implications for moving forward. J Vasc Surg. 2020; 73(6):1876-1880.e1. PMC: 7687586. DOI: 10.1016/j.jvs.2020.11.025. View

16.

Noba L, Wakefield A . Are carbohydrate drinks more effective than preoperative fasting: A systematic review of randomised controlled trials. J Clin Nurs. 2019; 28(17-18):3096-3116. DOI: 10.1111/jocn.14919. View

17.

Kruzik N . Benefits of preoperative education for adult elective surgery patients. AORN J. 2009; 90(3):381-7. DOI: 10.1016/j.aorn.2009.06.022. View

18.

Dock-Nascimento D, Aguilar-Nascimento J, Magalhaes Faria M, Caporossi C, Slhessarenko N, Waitzberg D . Evaluation of the effects of a preoperative 2-hour fast with maltodextrine and glutamine on insulin resistance, acute-phase response, nitrogen balance, and serum glutathione after laparoscopic cholecystectomy: a controlled randomized trial. JPEN J Parenter Enteral Nutr. 2012; 36(1):43-52. DOI: 10.1177/0148607111422719. View

19.

Agarwal A, Chari P, Singh H . Fluid deprivation before operation. The effect of a small drink. Anaesthesia. 1989; 44(8):632-4. DOI: 10.1111/j.1365-2044.1989.tb13581.x. View

20.

Cheng Z, Yang Q, Zhu P, Feng J, Zhang X, Zhao Z . Transesophageal Echocardiographic Measurements of the Superior Vena Cava for Predicting Fluid Responsiveness in Patients Undergoing Invasive Positive Pressure Ventilation. J Ultrasound Med. 2018; 38(6):1519-1525. DOI: 10.1002/jum.14839. View