[Preoperative Fluid Fasting in the Context of the Safe Brain Initiative - A Model for Patient-centered Precision Care...

Preoperative fasting is among the most routine measures in perioperative medicine. While fasting from solid food remains well justified, current evidence suggests that prolonged fluid fasting - particularly for clear liquids - places an unnecessary burden on patients without proven benefit and may be associated with unfavorable clinical outcomes. This review examines preoperative fluid fasting within the context of the Safe Brain Initiative (SBI) and the concept of Patient-centered Precision Care - (PC)². Using data from a multicenter registry analysis (n = 15837 patients), adherence to recommended fluid fasting intervals was shown to be associated with a lower incidence of postoperative delirium and a shorter hospital length of stay. At the same time, substantial implementation challenges are addressed transparently: despite considerable efforts, the median duration of fluid fasting remained 5 hours, and nearly 60% of patients fasted for more than 4 hours. A differentiated discussion of various fluid fasting regimens - from the conventional 2-hour rule to more liberal approaches such as "Sip-til-send" - is integrated into the (PC)² framework. For a more detailed discussion of current guideline recommendations and their practical implementation, readers are referred to the 2026 international consensus statement (DOI: 10.1111/anae.70130).