Observed preprocedural fasting duration and interventions intended to reduce them: A reference list-based review and...

Preprocedural fasting guidelines have been in place in the US since 1999. Many studies show that patients actually fast longer than the guidelines recommend.

To perform a detailed review based on the reference lists from and citations to articles known to be relevant to the topic. A meta-analysis of the observed preprocedural fasting literature and the interventions intended to reduce fasting times was performed.

A literature search was performed on multiple databases using the search term preoperative fasting combined with other terms such as aspiration. Reference lists from articles reporting results of observed fasting times were reviewed and all relevant articles titles were entered into Google Scholar to find articles that referenced them. Meta-analyses of the results were reported as mean (±SD) differences along with the degree of heterogeneity between studies. The final search was completed on July 31, 2024.

There were 79 articles of which 24 (44, 073 patients) reported pediatric and 31 (16, 039 patients) reported adult observed fasting times. There were 25 (76, 359 patients) articles reporting outcomes from interventions intended to reduce preprocedural fasting times. Because observed fasting times are measured in a relatively short period of time during which the patient is being managed by anesthesia, there was little risk for bias, missing data or problems of data integrity. Fasting duration from all the studies was considered high quality and all the quality assurance intervention studies were considered low quality. Mean observed pediatric fasting times for liquids was 7.1 h (95% CI: 5.7 to 8.5 h) and for solids it was 12.2 h (95% CI: 11.1 h, 13.2 h). Preprocedural liquid fasting times for adults were 10.3 h (95%CI: 9.3 h, 11.4 h) and 13.5 h (95% CI: 12.6 h, 14.3 h) for solids. Fasting times were reduced by QA interventions but not by patient education, change in hospital policy, staff education and text messaging.

Despite 25 years of guidelines recommending limited preprocedural fasting, observed fasting durations remain very long and are refractory to most efforts intended to reduce them.

OSF Tue Jun 14 2022 07:19:36 GMT-0700 https://osf.io/pdju4.