Research shows that surgical fasting rules may be outdated

Following medical guidelines, it can be traced back to 1946, when millions of patients endured no food or water without food.

However, a comprehensive analysis of modern research did not find that preoperative fasting actually prevented the dangerous complications it was designed to avoid, raising questions about whether this discomfort practice is still necessary.

UCLA researchers analyzed 17 studies involving nearly 1,800 patients and found that preoperative fasting had no association with preventing aspiration, a potentially fatal condition in which vomit enters the lungs during anesthesia. The discovery challenges one of the most common preoperative practices in medicine.

Questioning the orthodox concept of medicine

The fasting requirement was about 80 years ago, when doctors first identified a possible link between stomach content and inhaled pneumonia. Since then, patients are usually told to avoid food and water 8-12 hours before the surgery, creating one of the most frightening aspects of the surgery that many people call.

The UCLA team looked at randomized clinical trials and observational studies published between 2016 and 2023 specifically targeting witnessed inspiratory events rather than indirect measures. What they found surprised them: in 801 patients with fasting rules (0.50%), only 4 of the 990 patients after the traditional fasting regimen, 7 (0.71%).

The difference is not only statistically trivial, but actually favors fasting groups. The odds ratio of suction was 1.17 and the confidence interval span was 0.32 to 4.23, indicating no meaningful association between fasting duration and suction risk.

Main research results

This study reveals several important patterns of surgical fasting:

• Regardless of the duration of fasting
• Most previous studies have depended on alternative measures, such as stomach acid levels, rather than actual suction
• The experimental sequence analysis shows that future studies are unlikely to find different results
• Current hospital practices often go far beyond recommended guidelines
• Modern assessment methods such as stomach ultrasound can replace blanket fasting rules

Perhaps most convincingly, the researchers found that previous studies focused on measuring stomach volume and pH levels, factors that have never been shown to be associated with actual attacks in humans under anesthesia. This suggests decades of research may have been chasing the wrong endpoint.

Cautionary cost

“At some point, almost everyone will be under a procedure and there is a general policy in every healthcare facility that requires a degree of fasting before surgery,” explains Dr. Edward Livingston, professor of health sciences at the David Geffen School of Medicine at UCLA Medical School. “Fatting for a long time is very uncomfortable and patients really don’t like to do this.”

Researchers have examined realistic fasting practices in more than 80 hospitals and found that patients are usually faster than the guidelines suggest. This causes unnecessary pain without obvious medical benefits.

It is no surprise that the disconnection between the guide and practice is disconnected. The operating room schedule changes, the procedures are delayed, and the easiest solution is usually to have the patient “just in case.” However, if fasting does not prevent suction, then these prolonged discomforts are of little purpose.

Focus on personalized approaches

Instead of abandoning preventive measures altogether, the study points to more complex risk assessments. Modern technologies such as preoperative gastric ultrasound can directly visualize the stomach content, allowing doctors to make personalized decisions about when the surgery is safe.

The shift from universal rules to personalized medicine reflects a broader trend in health care. Instead of applying a certain level of all policies, the medical team can evaluate each patient’s specific risk factors and gastric status immediately before the surgery.

As medical practice develops, this study suggests that it may be time to rethink traditions that lead to patient discomfort without obvious benefits. The next step involves prospective trials that reduce fasting times, while modern surveillance ensures patient safety, ending with decades of unnecessary hunger for surgical patients.

Related