Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study

Abstract

José E de Aguilar-Nascimento,1 Ana L de Almeida Dias,2 Diana B Dock-Nascimento,3 Maria Isabel TD Correia,4 Antonio CL Campos,5 Pedro Eder Portari-Filho,6 Sergio S Oliveira71Department of Surgery, Julio Muller University Hospital, Cuiaba, Brazil; 2Federal University of Mato Grosso, Cuiaba, Brazil; 3Department of Sciences and Food, Federal University of Mato Grosso, Cuiaba, Brazil; 4Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil; 5Department of Surgery, Federal University of Parana, Curitiba, Brazil; 6Department of Surgery, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil; 7Service of Anesthesiology, Julio Muller University Hospital, Cuiaba, Brazil On behalf of the BIGFAST (Brazilian Group for the Study of Preoperative Fasting Time) group Background: Prolonged fasting increases organic response to trauma. This multicenter study investigated the gap between the prescribed and the actual preoperative fasting times in Brazilian hospitals and factors associated with this gap. Methods: Patients (18–90-years-old) who underwent elective operations between August 2011 and September 2012 were included in the study. The actual and prescribed times for fasting were collected and correlated with sex, age, surgical disease (malignancies or benign disease), operation type, American Society of Anesthesiologists score, type of hospital (public or private), and nutritional status. Results: A total of 3,715 patients (58.1% females) with a median age of 49 (18–94) years from 16 Brazilian hospitals entered the study. The median (range) preoperative fasting time was 12 (2–216) hours, and fasting time was longer (P<0.001) in hospitals using a traditional fasting protocol (13 [6–216] hours) than in others that had adopted new guidelines (8 [2–48] hours). Almost 80% (n=2,962) of the patients were operated on after 8 or more hours of fasting and 46.2% (n=1,718) after more than 12 hours. Prolonged fasting was not associated with physical score, age, sex, type of surgery, or type of hospital. Patients operated on due to a benign disease had an extended duration of preoperative fasting. Conclusion: Actual preoperative fasting time is significantly longer than prescribed fasting time in Brazilian hospitals. Most of these hospitals still adopt traditional rather than modern fasting guidelines. All patients are at risk of long periods of fasting, especially those in hospitals that follow traditional practices. Keywords: preoperative fasting, preoperative care, multicenter study, intraoperative complications, guideline adherence, perioperative risk