Pre-operative fasting in a cohort of patients undergoing surgery for fractured neck of femur – a retrospective cross-sectional study

Abstract

Background: Despite strong evidence indicating detrimental impacts, surgical patients often experience prolonged peri-operative fasting. Aim: The aim of this retrospective cross-sectional study was to assess duration of pre-operative fasting in a cohort of acute inpatients undergoing surgery for fractured neck of femur within a large tertiary referral hospital in Sydney, Australia; and to compare fasting times with recommended pre-operative fasting guidelines. Methods: Patients that underwent surgery for fractured neck of femur between February and September 2023 were retrospectively assessed for the length of pre-operative fasting. The pre-operative fasting period was defined as the time documented in the medical record that patients were advised to fast from the time of general anaesthetic administration as per operative records. Fasting times were compared to current evidence-based pre-operative fasting guidelines. Results: Ninety-two participants were included in this study, with a pre-operative fasting period from solids of 11.1 h (interquartile range [IQR] 5.5) and pre-operative fluids of 10.8 h (IQR 5.3). No participants were given the opportunity to have solids up to 6 h prior to surgery and/or pre-operative fluids up to 2 h prior to surgery as per current fasting guideline. Majority of participants were female with a median age of 82 (IQR 13.3) and over 40% were assessed as malnourished on admission to hospital. Conclusion: Pre-operative fasting greatly exceeded recommended fasting times. Given patients undergoing fractured neck or femur surgery are often older and at high nutrition risk, more research focusing on strategies to reduce excessive fasting is needed in this vulnerable population.