Real-World Evidence: How Long Do Our Patients Fast?-Results from a Prospective JAGO-NOGGO-Multicenter Analysis on Perioperative Fasting in 924 Patients with Malignant and Benign Gynecological Diseases

Abstract

Background: Despite the key role of optimized fasting in modern perioperative patient management, little current data exist on perioperative fasting intervals in routine clinical practice.

Methods: In this multicenter prospective study, the length of pre- and postoperative fasting intervals was assessed with the use of a specifically developed questionnaire. Between 15 January 2021 and 31 May 2022, 924 gynecology patients were included, from 13 German gynecology departments.

Results: On average, patients remained fasting for about three times as long as recommended for solid foods (17:02 ± 06:54 h) and about five times as long as recommended for clear fluids (9:21 ± 5:48 h). The average perioperative fasting interval exceeded one day (28:23 ± 14:02 h). Longer fasting intervals were observed before and after oncological or extensive procedures, while shorter preoperative fasting intervals were reported in the participating university hospitals. Smoking, treatment in a non-university hospital, an increased Charlson Comorbidity Index and extensive surgery were significant predictors of longer preoperative fasting from solid foods. In general, prolonged preoperative fasting was tolerated well and quality of patient information was perceived as good.

Conclusion: Perioperative fasting intervals were drastically prolonged in this cohort of 924 gynecology patients. Our data indicate the need for better patient education about perioperative fasting.

Keywords: ERAS; perioperative fasting; real-world evidence.

Figure 1

Perioperative fasting intervals. From top to bottom are shown average preoperative fasting duration for solid foods, average preoperative fasting duration for fluids, average postoperative fasting duration for solid foods and average total perioperative fasting duration for solid foods. Data are shown in hh:min. Error bars indicate standard deviation.

Figure 2

Condition during fasting. From right to left are shown: (A): Patients’ feelings of hunger during preoperative fasting. (B): Patients’ feelings of thirst during preoperative fasting. (C): Patients’ feelings of weakness during preoperative fasting. (D): Patients’ difficulties in adhering to fasting recommendations. Data are presented as a circle chart. Green indicates “no or none”, blue indicates “slight”, yellow indicates “moderate” and red indicates “strong”. Bellow the chart, the percentage of answers is displayed next to the legends. The number of patients is displayed in parentheses behind the percentage. n = number.