Surgical fasting guidelines in children: Are we putting them into practice?

Infographic · Oct 2018 · 1 min read

In brief

Prospective study of 53 pediatric surgical patients found 70% exceeded recommended preoperative fasting times, with median NPO periods of 10-11 hours regardless of procedure complexity. Findings suggest significant gap between evidence-based fasting guidelines and actual clinical practice in pediatric surgery.

70% of pediatric surgical patients fasted longer than recommended preoperatively, with median NPO times exceeding 10 hours.
Preoperative fasting duration did not differ significantly between complex and noncomplex procedures (11.5h vs 10.8h).
Most patients received postoperative NPO time even when not explicitly ordered by physicians, suggesting practice gaps.
Prolonged unnecessary fasting places pediatric patients at risk for undernutrition despite evidence-based guidelines.
Current institutional practices do not align with published safe fasting guidelines for children undergoing surgery.

Written by the GCMD Library team from the infographic.

A teal-colored infographic with a dark header section and main content area displaying four rows of fasting guidelines. Each row contains an icon (baby bottle, breastfeeding symbol, formula bottle, hamburger) paired with corresponding time intervals, arranged vertically. A prominent text callout on the right emphasizes a compliance issue.

Background

Patients are traditionally kept fasting (NPO) from midnight prior to surgery, to prevent aspiration during anesthesia. NPO time is continued postoperatively, out of concern for ileus. Prolonged periods of NPO place the pediatric population at risk for under-nutrition. Published guidelines for preoperative NPO times have been shown to be safe. The aim of this study was to investigate current pre- and postoperative feeding practices of children at a pediatric tertiary care hospital.

Methods

Medical charts were used to extract data prospectively from 53 patients undergoing general, neurosurgical, or urological procedures. Date and time of NPO periods were recorded as well as the physician's postoperative diet orders and diet progression. Surgical procedures were classified as complex or noncomplex by the surgeons. Data were summarized and compared to published recommendations.

Results

Preoperative NPO times were greater than recommended in 70% of patients studied (n = 37). Median time spent NPO preoperatively was not significantly different between complex (11.5 h) and noncomplex groups (10.8 h). Postoperative NPO time was significantly greater for complex procedures than for noncomplex. Most patients received some postoperative NPO time, even when it was not included in the physician diet order.