Fasting before surgery... a medical tradition at stake

Fasting before surgery... a medical tradition at stake
Challenging the tradition: New research questions the need to fast before surgery) / Aljazeera


A new systematic review is calling into question the decades-old medical guideline that requires patients to fast before undergoing surgery. Traditionally, patients are instructed to avoid food and drink for several hours prior to their procedure to prevent aspiration pneumonia, a complication that occurs when stomach contents enter the lungs under anesthesia.

What the Study Revealed

Published in the journal Surgery, the study analyzed data from 17 clinical trials involving a total of 1,791 patients—990 who fasted before surgery and 801 who did not. Surprisingly, the rate of pulmonary aspiration was nearly identical: 0.7% in the fasting group versus 0.5% in the non-fasting group.

Researchers concluded there was no significant evidence to suggest that any specific type or duration of fasting provided greater protection against aspiration during surgery.

Expert Insights

Dr. Edward Livingston, lead author of the study and professor at the David Geffen School of Medicine at UCLA, commented, “Nearly everyone undergoes a surgical procedure at some point, and globally, hospitals enforce fasting policies. But our findings show that prolonged fasting may not be necessary and can be quite uncomfortable for patients.”

Rethinking a Long-Held Tradition

Modern surgical protocols, such as those endorsed by the American Society of Anesthesiologists (ASA), already recommend more flexible fasting periods—such as allowing clear fluids up to 2 hours before anesthesia and solid foods up to 6 hours prior. Yet, many hospitals still enforce fasting from midnight, which can result in 8–12 hours without food or drink.

This study adds momentum to the push for evidence-based, patient-friendly guidelines that minimize discomfort without increasing surgical risks.

Patient-Centered Approach Recommended

  • Allow clear liquids up to two hours before surgery for low-risk patients.
  • Use individual risk assessment for patients with delayed gastric emptying or other complications.
  • Avoid blanket fasting rules; instead, tailor preoperative instructions to each patient's needs.

Conclusion

While more research is needed to fine-tune preoperative fasting recommendations, current evidence suggests that the practice, in its traditional form, may offer no additional benefit and may even cause unnecessary distress for patients. It’s time for healthcare providers to reconsider long-standing rules in favor of personalized, comfort-oriented surgical care.


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