Key result
Implementation of an improvement bundle did not significantly reduce median preoperative fasting times for clear fluids, which remained prolonged at 192 minutes compared to 185 minutes in the pre-intervention period (p=0.12).
Why the study?
The study was conducted to report updated results on pediatric preoperative fasting after enrolling new patients, evaluating clear and non-clear fluids and meals following the implementation of an improvement bundle.
Does an improvement bundle reduce preoperative fasting times in pediatric surgical patients?
Observational (n=2,516)
No
Does an improvement bundle reduce preoperative fasting times in pediatric surgical patients?
Absolute Event Rate: 192% vs 185%
p-value: p=0.12
Despite implementing an improvement bundle, preoperative fasting times for pediatric patients remain significantly longer than recommended by European guidelines.
Actual fasting times remain substantially longer than guidelines despite protocol implementation; leaves open the need for more effective strategies to reduce prolonged fasting in children.
BACKGROUND: We conducted a secondary analysis of a previously published dataset that addressed clear fluid fasting in children. The aim of this single-center, retrospective observational study conducted in a tertiary level pediatric hospital (Meyer Children's Hospital, Florence, Italy) was to report updated results after enrollment of new patients, including clear and non-clear fluids and meals. METHODS: Retrospective single-center study in a tertiary pediatric hospital after the implementation of an improvement bundle. RESULTS: Overall, we enrolled 2715 patients, and after exclusion of 199 children due to incomplete data retrieval, a final cohort of 2516 subjects (1074 surgical outpatients, 981 surgical inpatients, 314 neurosurgical procedures, 147 procedures from pediatrics/oncology) was analyzed. Median age was 7.5 (3.7-12.2) years. Median (interquartile range) preoperative fasting time was 187 (119-351) min for clear fluids, 286 (218-396) min for maternal milk, 360 (285-530) min for artificial milk, 435 (350-540) min for light breakfast, and 765 (640-910) min for meal. We did not find significant differences between the clear fluid times of the previous study (1820 patients, 185 (115-340) min) and the one analyzed in the present dataset (696 patients, 192 (120-363) min) (p = 0.12). CONCLUSION: In a pediatric hospital implementing European Society of Anesthesia recommendations for preoperative fasting, all fluids and meals are stopped very far from the scheduled times, and this notion should provide ignition for further improvement actions.
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Ricci et al. (2025) conducted an observational in Elective noncardiac surgery (n=2,516). Improvement bundle for preoperative fasting vs. Pre-intervention period was evaluated on Preoperative fasting time for clear fluids (minutes) (p=0.12). Implementation of an improvement bundle did not significantly reduce median preoperative fasting times for clear fluids, which remained prolonged at 192 minutes compared to 185 minutes in the pre-intervention period (p=0.12).
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