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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Simple Summary

The concept of ERAS (Enhanced Recovery After Surgery) was introduced to reduce perioperative morbidity through a multimodal approach. Optimized and shortened perioperative fasting is a fundamental part of this modern concept of perioperative patient management, as prolonged fasting before and after surgery is associated with unfavorable outcomes. So far, it remains unclear whether increasingly established ERAS protocols lead to adequate short fasting intervals in clinical routines. We therefore conducted this prospective multicenter study and collected real-world data from 924 patients to evaluate actual perioperative fasting behavior. Patients reported drastically prolonged perioperative fasting durations. Even longer fasting intervals were reported for oncological and extensive procedures. Our data suggest that modern optimized fasting management is poorly implemented in clinical routine practice. This study should draw attention to the need for adequate implementation of ERAS protocols and sensitize clinicians to appropriate patient education about perioperative fasting.

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.

Details

Title
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
Author
Maximilian Heinz Beck 1   VIAFID ORCID Logo  ; Balci-Hakimeh, Derya 2 ; Scheuerecker, Florian 3 ; Wallach, Charlotte 3 ; Hannah Lena Güngor 4 ; Lee, Marlene 5   VIAFID ORCID Logo  ; Ahmed Farouk Abdel-Kawi 6 ; Glajzer, Jacek 7 ; Vasiljeva, Jekaterina 8   VIAFID ORCID Logo  ; Kubiak, Karol 9 ; Jens-Uwe Blohmer 10   VIAFID ORCID Logo  ; Sehouli, Jalid 11   VIAFID ORCID Logo  ; Pietzner, Klaus 11   VIAFID ORCID Logo 

 Department of Gynecology, Breast Center, Campus Mitte, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117 Berlin, Germany; Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany 
 Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany; Department of Gynecology, St. Joseph Hospital, 12101 Berlin, Germany 
 Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany; Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany 
 Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany; Department of Gynecology, Katholisches Marienkrankenhaus—Klinik für Gynäkologie, 22087 Hamburg, Germany 
 Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany 
 Department of Gynecology, Katholisches Marienkrankenhaus—Klinik für Gynäkologie, 22087 Hamburg, Germany; Department of Gynecology, Faculty of Medicine, University of Assiut, Assiut 71515, Egypt 
 Department of Gynecology and Obstetrics, Breast Center Ostsachsen, Klinikum Oberlausitzer Bergland Zittau/Ebersbach, 02730 Ebersbach, Germany 
 Department of Gynecology, Vivantes Klinikum Am Urban, 10967 Berlin, Germany 
 Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany; Department of Gynecology and Obstetrics, St. Franziskus Hospital Muenster, 48145 Muenster, Germany 
10  Department of Gynecology, Breast Center, Campus Mitte, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117 Berlin, Germany 
11  Young Academy of Gynecologic Oncology (JAGO), Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie, 13359 Berlin, Germany; Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany 
First page
1311
Publication year
2023
Publication date
2023
Publisher
MDPI AG
e-ISSN
20726694
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2779451825
Copyright
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.