Pre-operative fasting in elective breast surgery patients: have times improved with the introduction of a new guideline?

An audit of pre-operative fasting.

Fergus Taylor https://fergustaylor.github.io/Dev/ (University of Glasgow)https://www.gla.ac.uk/ , S Halliday (Gartnavel Hospital) , P O’Keane (University of Glasgow) , C Urquhart (Gartnavel Hospital)
09-22-2015

Elective surgical patients are required to fast, in order to reduce the risk of pulmonary aspiration of gastric contents [1]. For multiple reasons, many patients fast for longer than recommended. Prolonged fasting has many detrimental effects; including dehydration, electrolyte imbalances and hypoglycaemia, as well as exacerbating the postoperative stress response [2]. Furthermore, protracted fasting is also unpleasant for patients and can induce distress and fatigue. A previous audit in our hospital showed that elective breast surgery patients were fasting for excessive periods. A new fasting guideline and patient information sheet has since been introduced across our health board. We sought to determine if this new guideline and staff education have improved the duration of pre-operative fasting in elective breast surgery patients in our hospital.

Methods:

Over a five-week period, a re-audit was conducted on elective breast surgery patients. Patients were interviewed to determine their fasting times for food and clear fluids, and what information they had received on fasting.

Results:

Data were collected for 24 elective breast surgery patients. The mean fasting time for food was 15 h 10 min (range 8 h 50 min to 21 h 5 min); [previous data 15 h 24 min (range 11 h 0 min to 21 h 30 min)]. The mean fasting time for clear fluids was 8 h 35 min (range 1 h 5 min to 16 h 20 min); [previous data 13 h 13 min (range 3 h 10 min to 19 h 15 min)]. Twenty patients recalled being instructed to fast from food, as of midnight, and clear fluids from 6 am or 6.30 am. Four patients stated that they had been advised to fast entirely from midnight. Twenty patients recalled being given written information on fasting, whereas ten patients received written and verbal information. Two patients received only verbal information.

Discussion:

From this re-audit it is evident that elective breast surgery patients in our centre are continuing to fast for excessive periods, although slightly less than previously. Disappointingly, patients allocated to the afternoon list were told to fast from midnight, and did not all receive water on the ward in the morning. Although not measured here, this may be having harmful affects on their postoperative recovery. Alarmingly, two patients were given written information to fast completely from midnight, despite this not being on the new patient information leaflet. An improvement in fasting practices has been seen following introduction of the new guidelines and patient information leaflets. Further staff education is required to ensure the correct information is disseminated to patients to enable additional progress to be made.

References

  1. AAGBI Safety Guideline; Pre-operative assessment and patient preparation. The role of the anaesthetist. The Association of Anaesthetists of Great Britain & Ireland. London, 2010.
  2. Nygren J. The metabolic effects of fasting and surgery. Best Practice & Research Clinical Anaesthesiology 2006; 20: 429-438.

Corrections

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Citation

For attribution, please cite this work as

Taylor, et al., "Academic: Pre-operative fasting in elective breast surgery patients: have times improved with the introduction of a new guideline?", Anaesthesia, 2015

BibTeX citation

@article{taylor2015pre-operative,
  author = {Taylor, Fergus and Halliday, S and O’Keane, P and Urquhart, C},
  title = {Academic: Pre-operative fasting in elective breast surgery patients: have times improved with the introduction of a new guideline?},
  journal = {Anaesthesia},
  year = {2015},
  doi = {10.1111/anae.13223}
}