小児外科入院患者の絶食時間に関連する要因

Shorter fasting periods before and after surgery have been associated with better postoperative recovery and lower morbidity and mortality. However, it is not always possible to achieve current recommendations in pediatric practice. Therefore, it is essential to study fasting time and its associated factors to implement better care strategies.

Cohort of 284 pediatric patients admitted for surgery between 2020-2021, Hospital São Paulo, Brazil. Data was collected through interviews and medical records. Simple and multiple linear models and logistic regression models were adjusted to study the associations.

All preoperative patients fasted for a prolonged period and most resumed feeding 6 hours after the end of anesthesia. Preoperative fasting time was shorter for elective surgery than for urgent surgery (p=0.025). Factors associated with a longer preoperative fasting time (minutes) were: older age in years (ß=10; 95% CI=5.2-14.8) and history of previous surgery (ß=76.6; 95% CI=28.0-125.1). Factors associated with postoperative fasting time longer than 6 hours were: no immediate postoperative care in the surgical ward (OR=6.05; 95%CI=2.25-16.22), presence of complications during surgery (OR=3. 53; 95%CI=1.19-10.47), major operation size (OR=3.85; 95%CI=1.49-9.93), abdominal surgery (OR=36.52; 95%CI=13.48-98.91) and vomiting in the first 24 hours (OR=3.44; 95%CI=1.54-7.69).

There are potentially modifiable factors associated with longer fasting times. Education and organization of the healthcare team regarding patient characteristics, care dynamics, and clinical complications may contribute to greater optimization of fasting times in pediatric surgical patients.