Evaluation of dietitian’s knowledge about fasting abbreviation protocols and the actual preoperative fasting time practiced
DOI:
https://doi.org/10.12957/demetra.2025.85543Keywords:
Fasting. Preoperative Care. Knowledge. Dietitians. Enhanced.Abstract
Objective: To assess the knowledge of dietitians regarding fasting abbreviation and the preoperative fasting time practiced in hospitals in the state of Rio de Janeiro, Brazil. Methods: This is a cross-sectional, descriptive study involving clinical dietitians who work in hospitals in the state of Rio de Janeiro. Data were collected through the application of an online structured questionnaire and analyzed through descriptive statistics and the Chi-Square test to verify associations at a significance level of 5%. Results: Out of the 84 participating dietitians, 85% had heard about fasting abbreviation and supplements for this purpose, but 31.33% did not correctly describe current recommendations. In 48.81% of hospitals, the actual preoperative fasting time exceeds 12 hours, and 51.81% do not have a fasting abbreviation protocol. According to dietitians, fasting abbreviation is a practice that reduces surgical stress (91.57%), recommended for all types of surgeries, regardless of size (65.43%). The resistance of professionals to adopting new practices was identified as the main challenge to implementing the fasting abbreviation protocol (78.79%). There was no association between the overall knowledge level of professionals, the length of education, and specialization (p > 0.05). Conclusion: The high level of knowledge among dietitians about fasting abbreviation contrasts with the maintenance of traditional preoperative fasting techniques. The absence of institutional protocols and ineffective communication among teams strongly contribute to the non-incorporation of new practices into perioperative routines.
Downloads
References
1. Mendelson CL. The aspiration of stomach contents into the
lungs during obstetric anesthesia. Am J Obstet Gynecol.
1946;52(2):191-205. https://doi.org/10.1016/s0002-9378(16)39829-5.
2. Friedrich S, Meybohm, P, Kranke P. Nulla Per Os (NPO) guidelines: time to revisit?.Curr Opin Anaesthesiol. 2020;33(6):740-45. https://doi.org/10.1097/ACO.0000000000000920
3. American Society of Anesthesiologists Committee (ASA). Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologists Task Force on Preoperative Fasting. Anesthesiology. 1999;90:896-905. https://doi.org/10.1097/ALN.0000000000001452.
4. Fearon KCH, Ljungqvist O, Von Meyenfeldtc M, Revhaugd A, Dejongc CHC, Lassend K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466-477. https://doi.org/ 10.1016/j.clnu.2005.02.002.
5. Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C, Silva RDM, Cardoso EA, Santos TP. Acerto pós-operatório: avaliação dos resultados da implantação de um protocolo multidisciplinar de cuidados peri-operatórios em cirurgia geral. Rev Col Bras Cir. 2006;33(3):181-188. https://doi.org/10.1590/S0100-69912006000300010.
6. Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: Time to change practice? Can Urol Assoc J. 2011;5(5):342-348. https://doi.org/10.5489/cuaj.11002.
7. Aguilar-Nascimento JE, Bicudo-Salomão A, Waitzberg DL, Dock-Nascimento DB, Correa MIT, Campos ACL, et al. Diretriz ACERTO de intervenções nutricionais no perioperatório em cirurgia geral eletiva. Ver Col Bras Cir. 2017; 44(6):633-648. https://doi.org/10.1590/0100-6991201700600.
8. Evans DC, Martindale RG, Kiraly LN, Jones CM. Nutrition optimization prior to surgery. Nutr Clin Pract. 2014; 29(1):10-21. https://doi.org/10.1177/0884533613517006.
9. Morrison CE, Ritchie-Mclean S, Jha A, Mythen M. Two hours too long: time to review fasting guidelines for clear fluids. Br J Anaesth. 2020; 124(4):363-366. https://doi.org/ 10.1016/j.bja.2019.11.036.
10. Ljungqvist O, Boer HD, Balfour A, Fawcett WJ, Lobo DN, Nelson G, et al. Opportunities and challenges for the next phase of enhanced recovery after surgery: a review. JAMA Surg. 2021;156(8):775-784. https://doi.org/ 10.1001/jamasurg.2021.0586.
11. Denkyi L. An exploration of pre-operative fasting practices in adult patients having elective surgery. Br J Nurs. 2020;29(7):436-441. https://doi.org/ 10.12968/bjon.2020.29.7.436.
12. Zhu Q, Li Y, Deng Y, Chen J, Zhao S, Bao K, Lai L.Preoperative fasting guidelines: where are we now? findings from current practices in a tertiary hospital. J Perianesth Nurs 2021; 36(4): 388-392. https://doi.org/ 10.1016/j.jopan.2020.09.002.
13. Conselho Federal de Nutricionista (CFN). Resolução CFN nº 600, de 25 de fevereiro de 2018. Dispõe sobre a definição das áreas de atuação do nutricionista e suas atribuições, indica parâmetros numéricos mínimos de referência, por área de atuação, para a efetividade dos serviços prestados à sociedade e dá outras providências. Diário Oficial da União. 20 abr 2018; 76(Seção 1):157-211.
14. Oliveira MJF, Araujo AJS, Mazer VB. Papel do nutricionista em uma equipe de saúde hospitalar multiprofissional: percepção e expectativas de seus integrantes. BRASPEN J. 2020;35(3):270-278. https://dx.doi.org/10.37111/braspenj.2020353012.
15. Brasil. Resolução nº 466, de 12 de dezembro de 2012. Aprova as seguintes diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, 13 jun 2013; 12 (Seção 1):59-70.
16. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189-198. https://doi.org/10.1097/SLA.0b013e31817f2c1a.
17. Chen Z, Liu AJ, Cen Y. Fast-track program vs traditional care in surgery for gastric cancer. World J Gastroenterol. 2014;20(2):578-583, 2014. https://doi.org/10.3748/wjg.v20.i2.578.
18. Nogueira RT, Costa VVL, Sató A. Análise unicêntrica do tempo de jejum pré-operatório em pacientes submetidos à cirurgia cardíaca. BRASPEN J. 2019;34(2):139-144.
19. Panjiar P, Kochhar A, Vajifdar H, Bhat K. A prospective survey on knowledge, attitude and current practices of pre-operative fasting amongst anaesthesiologists: A nationwide survey. Indian J Anaesth 2019;63(5):350-355. https://doi.org/10.4103/ija.IJA_50_19.
20. Paul PA, Joselyn AS, Pande PV, Gowri M. A cross sectional, observational study to evaluate the surgeons’ knowledge and perspective on preoperative fasting guidelines in a tertiary care teaching hospital in Southern India. J Anaesthesiol Clin Pharmacol. 2022;38(3):434-439. https://doi.org/10.4103/joacp.JOACP_413_20.
21. Gupta N, Patnaik S, Lakkegowda LB, Jaiswal A, Dwivedi D. Preoperative fasting: knowledge, attitude, and practice of postgraduate trainees at a tertiary care hospital—an observational study. Ain-Shams J Anesthesio. 2022;14(1):23-30. https://doi.org/10.1186/s42077-022-00230-5.
22. American Society of Anesthesiologists Committee (ASA). Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2017;114(3):495-511. https://doi.org/10.1097/ALN.0000000000001452
23. Peden CJ; Aggarwal G, Aitken RJ, Anderson ID, Foss NB, Cooper Z, et al. Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society recommendations: part 1—preoperative: diagnosis, rapid assessment and optimization. World J Gastroenterol. 2021;45(5):1272-1290. https://doi.org/10.1007/s00268-021-05994-9.
24. Joshi GP, Abdelmalak BB, Weigel W. A.; Kuo, C. I.; Stricker, P. A.; Tipton, T, et al. American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration—A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. Anesthesiology. 2023;138(2):132-151. https://doi.org/10.1097/ALN.0000000000004381.
25. Smith I, Kranke P, Murat I, Smith A, O’Sullivan G, Søreide E, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur. J. Anaesthesiol. 2011;28(8):556-569. https://doi.org/ 10.1097/EJA.0b013e3283495ba1.
26. Yimer AH, Haddis L, Abrar M, Seid AM. Adherence to pre-operative fasting guidelines and associated factors among pediatric surgical patients in selected public referral hospitals, Addis Ababa, Ethiopia: Cross sectional study. Ann Med Surg. 2022;78:103813. https://doi.org/10.1016/j.amsu.2022.103813.
27. Carey S, Hogan S. Failure in Systems and Culture: Barriers That Prevent Implementation of Evidence‐Based Fasting Times for Patients in the Acute Care Setting. J Parenter Enteral Nutr. 2021;45(5):933-940. https://doi.org/ 10.1002/jpen.1961.
28. Carvalho CALDB, Carvalho AAD, Preza AD, Nogueira PLB, Mendes KBV, Dock-Nascimento DB, DE Aguilar-Nascimento JE. Benefícios Metabólicos e Inflamatórios da Abreviação do Jejum Pré-operatório em Cirurgia Pediátrica. Ver Col Bras Cir. 2020;47:p:e20202353. https://doi.org/10.1590/0100-6991e-20202353.
29. Rawlani SS, Dave NM, Karnik PP. The preoperative fasting conundrum: an audit of practice in a tertiary care Children’s Hospital. Turk J Anaesthesiol Reanim, 2022;50(3):207-212. https://doi.org/10.5152/TJAR.2022.21132.
30. Murphy GS, Ault ML, Wong HY, Szokol JW. The effect of a new NPO policy on operating room utilization. J Clin Anesth 2000;12(1):48-51. https://doi.org/10.1016/s0952-8180(99)00139-7.
31. Lambert E, Carey S. Practice guideline recommendations on perioperative fasting: a systematic review. J Parenter Enteral Nutr. 2016;40(8):1158-1165. https://doi.org/10.1177/0148607114567713.
32. Pedroso CGT, Sousa AAD, Salles RKD. Cuidado nutricional hospitalar: percepção de nutricionistas para atendimento humanizado. Ciênc. Saúde Colet. 2011;16(Supl.1):1155-1162. https://doi.org/10.1590/S1413-81232011000700047
33. Bosse G, Breuer J, Spies C. The resistance to changing guidelines–what are the challenges and how to meet them. Best Pract Res Clin Anaesthesiol. 2006;20(3):379-395. https://doi.org/10.1016/j.bpa.2006.02.005.
34. Cohen R, Gooberman-Hill R. Staff experiences of enhanced recovery after surgery: systematic review of qualitative studies. BMJ open, 2019;9(2):e022259. https://doi.org/10.1136/bmjopen-2018-022259
35. Byrnes A, Young A, Mudge A, Banks M, Bauer J. Exploring practice gaps to improve PERIoperativ E Nutrition CarE (EXPERIENCE Study): a qualitative analysis of barriers to implementation of evidence-based practice guidelines. Eur J Clin Nutr. 2019;73(1):94-101. https://doi.org/10.1038/s41430-018-0276-x.
36. Ahmad H, Shehdio W, Tanoli O, Deckelbaum D, Pasha T. Knowledge, Implementation, and Perception of Enhanced Recovery After Surgery Amongst Surgeons in Pakistan: A Survey Analysis. Cureus. 2023;15(9). https://doi.org/10.7759/cureus.46030
37. Çakar E, Yilmaz E, ÇAkar E, Baydur H. The effect of preoperative oral carbohydrate solution intake on patient comfort: a randomized controlled study. J of Peri Anesth Nurs 2017;32(6):589-599. https://doi.org/10.1016/j.jopan.2016.03.008.
38. Dorrance M, Copp M. Perioperative fasting: A review. J Perioper Pract. 2020;30(7-8):204-209. https://doi.org/10.1177/1750458919877591.
39. Sharma V, Prasad J, Choudhary K, Choudhary D. Traditional Prolonged Fasting: It’s Need of Time to Change the Practice-A Prospective Observational Study. Eur J Mol Clin Med. 2022;9(3):2245-2254.
40. Salman OH, Asida SM, Ali HS. Current knowledge, practice and attitude of preoperative fasting: A limited survey among Upper Egypt anesthetists. Egypt J Anaesthesia. 2013;29(2):125-130. https://doi.org/10.1016/j.egja.2012.10.007
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Rafaela Batista Coutinho Coutinho, Priscilla Alves Barreto, Thiago Huaytalla Silva
This work is licensed under a Creative Commons Attribution 4.0 International License.
STATEMENT OF AUTHORSHIP RESPONSIBILITY
Title of the manuscript:
________________________________________________________
1. Statement of responsability
I certify that I have participated in the work above specified and take public responsibility for its content.
I certify that the manuscript represents an original work and that none of the material in the manuscript has been previously published, is included in another manuscript, or is currently under consideration for publication elsewhere, whether in printed form or in electronic media, except that described in the attachment.
In case of acceptance of this text by Demetra: Alimentação, Nutrição & Saude, I declare to be in accordance with the policy of public access and copyright adopted by Demetra, which provides as follows: (a) the authors retain the copyright and grant to the Journal the right of first publication, the work being simultaneously licensed under the Creative Commons Attribution License, which allows the sharing of the work with acknowledgment of authorship and initial publication in this journal; (b) authors are authorized to enter additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, publishing in institutional repository or book chapter), with acknowledgment of authorship and initial publication in this journal; and (c) authors are permitted and encouraged to post and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this may lead to productive changes, as well as increase the impact and citation of the published work.
2. Conflict of Interest Statement
I certify that there is no conflict of interest in connection with the submitted article.
Date, signature and full address of all authors.
