Factors associated with fasting time in pediatric patients hospitalized for surgery
Laura Naspitz1, Fernanda Luísa Ceragioli Oliveira1,2, Renato Lopes DE Souza1
1- Universidade Federal de São Paulo, Pediatria - São Paulo - SP - Brasil.
Insights
Pediatric surgical patients often experience prolonged fasting. Factors like age, prior surgery, and complications influence fasting duration, highlighting opportunities for improved care strategies and patient outcomes.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Clinical Nutrition
Background:
- Shorter fasting periods improve postoperative recovery and reduce risks.
- Current fasting recommendations are challenging to implement in pediatric surgical practice.
- Understanding factors influencing fasting times is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To investigate the duration of preoperative and postoperative fasting in pediatric surgical patients.
- To identify factors associated with prolonged fasting times in this population.
Main Methods:
- A cohort of 284 pediatric patients undergoing surgery was studied.
- Data collected via interviews and medical records from 2020-2021.
- Statistical models (linear and logistic regression) were used to analyze associations.
Main Results:
- All patients experienced prolonged preoperative fasting; most resumed feeding 6 hours post-anesthesia.
- Preoperative fasting was shorter for elective vs. urgent surgeries.
- Older age, prior surgery, lack of immediate postoperative care, surgical complications, major operation size, abdominal surgery, and vomiting were linked to longer fasting times.
Conclusions:
- Potentially modifiable factors contribute to extended fasting durations in pediatric surgical patients.
- Enhanced healthcare team education and organization can optimize fasting times.
- Improved management of patient characteristics and clinical complications is key to better care.
Introduction:
Shorter fasting periods before and after surgery have been associated with better postoperative recovery and lower morbidity and mortality. However, it is not always possible to achieve current recommendations in pediatric practice. Therefore, it is essential to study fasting time and its associated factors to implement better care strategies.
Methods:
Cohort of 284 pediatric patients admitted for surgery between 2020-2021, Hospital São Paulo, Brazil. Data was collected through interviews and medical records. Simple and multiple linear models and logistic regression models were adjusted to study the associations.
Results:
All preoperative patients fasted for a prolonged period and most resumed feeding 6 hours after the end of anesthesia. Preoperative fasting time was shorter for elective surgery than for urgent surgery (p=0.025). Factors associated with a longer preoperative fasting time (minutes) were: older age in years (ß=10; 95% CI=5.2-14.8) and history of previous surgery (ß=76.6; 95% CI=28.0-125.1). Factors associated with postoperative fasting time longer than 6 hours were: no immediate postoperative care in the surgical ward (OR=6.05; 95%CI=2.25-16.22), presence of complications during surgery (OR=3. 53; 95%CI=1.19-10.47), major operation size (OR=3.85; 95%CI=1.49-9.93), abdominal surgery (OR=36.52; 95%CI=13.48-98.91) and vomiting in the first 24 hours (OR=3.44; 95%CI=1.54-7.69).
Conclusion:
There are potentially modifiable factors associated with longer fasting times. Education and organization of the healthcare team regarding patient characteristics, care dynamics, and clinical complications may contribute to greater optimization of fasting times in pediatric surgical patients.
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