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Practice Guideline Recommendations on Perioperative Fasting: A Systematic Review
Eva Lambert1, Sharon Carey2,3
1University of Sydney, Sydney, Australia.
JPEN. Journal of Parenteral and Enteral Nutrition
|January 11, 2015
Summary
Minimize perioperative fasting for better patient outcomes. Evidence supports a 2-hour clear fluid fast pre-surgery and early oral intake post-surgery for enhanced recovery.
Area of Science:
- Medical Guidelines
- Surgical Recovery Protocols
Background:
- Traditional perioperative fasting practices (nil by mouth from midnight, delayed postoperative intake) are outdated.
- Excessive fasting negatively impacts patient outcomes and recovery.
- Enhanced recovery protocols incorporating minimized fasting show promise but face limited implementation.
Purpose of the Study:
- Review current perioperative fasting guidelines.
- Assess the quality of these guidelines.
- Summarize evidence-based recommendations and identify research gaps.
Main Methods:
- Systematic literature search (Medline, CINAHL) and website searches for guidelines.
- Quality assessment using the Appraisal of Guidelines Research and Evaluation (AGREE) tool.
- Standardization of grading systems and summarization of recommendations.
Main Results:
- Nineteen guidelines were analyzed; rigor of development varied (29%-95%), with few reporting systematic methodology.
- Applicability scores were low (average 32%).
- Strong evidence supports minimizing perioperative fasting, a 2-hour clear fluid preoperative fast, and early postoperative oral intake.
Conclusions:
- High-level recommendations for minimizing perioperative fasting are ready for implementation.
- Areas for future research identified due to poorly graded and inconsistent recommendations.
- Guideline quality needs improvement in rigor and applicability through systematic methods and transparency.
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