Perioperative Fasting and the Patient Experience

Standard preparation for a surgical procedure requires patients to fast (nulla per os [NPO]) after midnight before their operation. Unfortunately, given the unpredictable nature of operating room scheduling and unavoidable delays, patients may find themselves anxiously waiting and fasting much longer than expected. In recent years, the usefulness of prolonged fasting to prevent pulmonary aspiration has been questioned. According to the American Society of Anesthesiologists (ASA) guidelines, unnecessarily prolonged fasting can be avoided by allowing patients to have clear liquids with the minimal fasting time of only two hours. This study examines a random sampling of elective scheduled surgeries at a 439-bed safety-net teaching hospital in Southern California in October 2016. The study revealed significantly prolonged NPO times caused by delays in the scheduling of operation times. An analysis of delays revealed that prior surgical procedures running longer than scheduled were the most common reason for a delay in starting an operation and, subsequently, prolonging patient fasting time. Significantly prolonged fasting times warrant the need for institutional management strategy changes and a revamping of clinical education curriculums.