AB176. SOH24AB_191. Preoperative fasting times for elderly patients undergoing elective surgery

Background: As per the European Society for Anaesthesiology guidelines, patients may safely consume a light meal up to six hours preoperatively, and unlimited clear fluids up to two hours preoperatively. Most hospitals, however, inappropriately adopt the traditional practice of requesting patients to ‘fast from midnight’. Prolonged fasting is associated with a multitude of adverse effects, to which our elderly patients are particularly sensitive to.

Methods: A prospective audit was carried out over a one-month period in March 2023 in which all patients aged ≥60 years presenting for elective surgery were questioned with regards to their fasting status.

Results: A total of 46 patients were included, with an average age of 71.4 years. The average time spent fasting was 8.6 hours for clear fluids, and 14.8 hours for food or non-clear fluids. 19.5% of patients experienced a delay of ≥2 hours between their scheduled theatre time and actual arrival to theatre. 28% of patients were called to theatre after midday.

Conclusions: Elderly patients are fasting for inappropriately prolonged periods preoperatively. With almost a third of patients undergoing surgery after midday, consideration should be given to introducing specific instructions to allow select patients consume a light breakfast at 6am on the morning of surgery. In addition, teams should be conscious of likely delays on the surgical lists and consider offering clear fluids to those expected to be waiting longer than two hours. Such changes support an evidence-based and patient centric approach to fasting and may reduce the risks associated with inappropriately long fasting periods.

Keywords: Elderly patients; fasting guidelines; preoperative fasting; preoperative fluids; inappropriate fasting