Fasting leads to fasting: examining the relationships between perioperative fasting times and fasting for symptoms in patients undergoing elective abdominal surgery

Background and Objectives: A growing body of evidence indicates traditional perioperative care practices of extended fasting and delayed feeding are outdated and detrimental to patient prognosis. This study aimed to explore associations between perioperative fasting, progression to solids and fasting for symptoms; assessing whether excessive pre-operative fasting results in further fasting post-operatively. Methods and Study Design: Two hundred patients who underwent elective surgery from March 2015 to June 2015 in upper gastrointestinal, colorectal and urological departments of a major teaching hospital were included in the study. A retrospective medical record audit was conducted to determine patient demographics, clinical data, perioperative fasting times and diet progression. Results: Preoperative fasting significantly correlated with time taken to progress to solids (rs(198)=0.180, p=0.011), but not with postoperative fasting. Patients who experienced subsequent fasting episodes for symptom management had a significantly longer postoperative fasting time (Med=25.5 hours +/-19.7) than those who did not (Med=6.2 hours +/-38.7, p=0.025). Significant differences in fasting times and diet progression were found based on Enhanced Recovery After Surgery (ERAS) status, magnitude of surgery, surgical department, and morning versus afternoon operating lists. Conclusions: Associations between extended perioperative fasting times, diet progression, and fasting for symptoms exist, such that the adverse effects of suboptimal nutritional status on recovery may be traced back to before the patient even arrives for surgery. Challenges of reducing fasting times may be overcome with repeated training of clinicians with best practice guidelines, and improving postoperative adherence to ERAS protocols.