Knowledge, attitude and practice of pre-operative fasting in gastrointestinal surgery: Post-operative complications

Although there are evidence-based guidelines for the recommended approach to pre-operative fasting, there is still an ongoing pattern of extended use of pre-operative fasting ("nil by mouth after midnight") in gastrointestinal surgeries which may result in increased levels of patient discomfort as well as post-operative complications. Therefore, it is of interest to evaluate patients' knowledge, attitudes and practices (KAP), related to pre-operative fasting among 200 elective gastrointestinal surgical patients and to assess its association with post-operative outcomes. The average fasting duration was 10.8 ± 2.7 hours for solids and 8.2 ± 2.3 hours for liquids, which was significantly longer than the guideline recommendations and the patients had higher rates of nausea, dehydration and wound infections as evidenced by lower KAP scores (p < 0.05). Those patients who had a better understanding of pre-operative fasting as well as better practices of pre-operative fasting had shorter fasting periods and reduced complications after surgery. Thus, we show that a structured patient-centered approach for pre-operative fasting education and standardized means for communicating pre-operative fasting instructions lead to decreased periods of fasting and improved overall perioperative outcomes following gastrointestinal surgery.