Preoperative fasting: when failure to measure perpetuates harm

Preoperative liquid fasting durations remain unacceptably long worldwide and represent one of the most common yet under-recognised sources of avoidable perioperative harm. Recent international multidisciplinary consensus has emphasised the need for institutional implementation strategies that recommend, where appropriate, more liberal clear liquid protocols to minimise prolonged fasting. Meaningful improvement therefore requires active implementation through routine measurement and audit of actual fasting durations relative to society recommendations, institutional accountability, and quality improvement initiatives that bridge the evidence-practice gap. Failure to implement strategies that prevent known harm is not a passive omission but an active decision, and addressing prolonged fasting is fundamental to delivering patient-centred perioperative care, improving the patient experience, and enhancing quality of recovery. Reducing prolonged perioperative fasting is a patient safety priority, not simply a guideline recommendation.