Long-term NPO Is a Severe Concern for the Development of Malnutrition in Hospitalized Patients: A Prospective Observational Study

Background: Before elective procedures, patients should be fasted to reduce the risk of pulmonary aspiration due to anesthesia. However, the fasting protocol is sometimes not implemented correctly, and patients are nil per oral (NPO) for an inappropriately long time. For this reason, the authors investigated the NPO duration of hospitalized patients before elective procedures and its relationship with nutritional status, patient outcomes, and 28-day mortality. Methods: A prospective observational cohort study was conducted on hospitalized patients who had experienced fasting before elective procedures. Data on demographics, anthropometric index, Mid-upper arm circumference, NRS-2002 questionnaire, length of hospital stay, and 28-day mortality rate were collected. Pearson correlation coefficient test, receiver operating characteristic (ROC) curves, and Kaplan-Meier analysis were also used. Results: Among 1135 hospitalized patients in different wards, 251 were included. The mean duration of fasting before elective procedures was 31.76±33.02 hours (mostly before elective surgeries). During the NPO period, patients lost 2769.20±2960.24 Kcal and 116.65±124.01 g protein. Moreover, about 41.9% of patients stayed in the hospital for more than 30 days, and 21.1% of patients died in less than 28 days; most of them suffered from malnutrition. Longer NPO duration was related to the rate of 28-day mortality in malnourished hospitalized patients. Conclusions: The results of this study indicated that patients experienced long-term NPO duration before elective procedures, and they lost daily calories and protein requirements, which led to worsening hospital malnutrition and increased length of stay (LOS), ventilator connection, and 28-day mortality.