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Pre-operative liquid fasting practices in twelve European countries: A prospective multicentre cohort study (Thirst
Anne Marie Camilleri Podesta1, Stephen Sciberras, Emanuel Moisa
1From the Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Malta (AMCP); Department of Surgery, Faculty of Medicine and Surgery, University of Malta, Msida, Malta (AMCP); Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Malta (SS); 3rd Department of Anesthesiology and Critical Care, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (EM); Department of Anesthesiology and Critical Care, Elias Emergency University Hospital of Bucharest, Bucharest, Romania (EM); Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Malta (LV); Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Malta (SF); Department of Anaesthesia and Intensive Care Medicine, Barmherzige Brüder Hospital, Salzburg (PP); Anaesthesia Department of Nikaia General Hospital, Piraeus, Greece (PK); Vilnius University, Faculty of Medicine, Institute of Clinical medicine, Clinic of Anesthesiology and Intensive Care; Vilnius University Hospital Santaros Clinics (DG); Unidade Local de Saúde de São João (SV); Yerevan State Medical University, Armenia (AV); Faculty of Medicine and Life Sciences, University of Latvia, Riga, Latvia (IG); Department of Anaesthesiology, Hospital of Traumatology and Orthopaedics, Riga, Latvia (IG); University Clinic for Traumatology, Orthopedic Diseases, Anaesthesia, Resuscitation, Intensive Care and Emergency Center, Clinical Center "Mother Theresa", Skopje, North Macedonia (VD); Caucasus Medical Centre, Vian corporation (MC); Mother Teresa UHC, Tirana, Albania (SK); Department of Anesthesiology, Reanimation and Intensive Care, Clinical Center of Montenegro (BV); Tor Vergata University, Rome, Italy (FB).
Background:
International guidelines recommend pre-operative clear liquid fasting for 2 h before anaesthesia. However, excessive fasting times remain widespread, potentially contributing to patient discomfort and adverse clinical outcomes.
Objective:
To evaluate current pre-operative liquid fasting practices among adults undergoing elective procedures across multiple European centres.
Design:
Prospective, observational, multicentre study.
Setting:
Forty-six centres in 12 European countries, conducted between November and December 2024.
Patients:
A total of 5100 adults undergoing elective surgery or interventional procedures under general anaesthesia, regional anaesthesia or sedation.
Main Outcome Measures:
Self-reported duration of pre-operative liquid fasting; incidence of prolonged fasting duration (defined as liquid fasting times of more than 4 h). Median [IQR] fasting time was calculated, with subgroup analyses by country and procedure type.
Results:
The median [IQR] pre-operative liquid fasting time was 12 [10 to 14.6] h. Only 4% of patients consumed clear liquids within 2 to 4 h, and 0.8% within 2 h. Fasting durations were consistently prolonged across most countries and procedures, except for notably shorter times in Albania. Overall, 95% of patients fasted beyond 4 h.
Conclusions:
Excessive pre-operative liquid fasting remains highly prevalent across Europe, with poor implementation of established guidelines. These findings underscore the need for educational, institutional, and quality improvement interventions to align clinical practice with evidence-based recommendations and enhance patient-centred care.
Trial Registration:
ClinicalTrials.gov identifier: NCT06527703.
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