Research on shortening preoperative fasting and fluid restriction time in day surgery patients through process optimization based on action research method_West China Medical Journal

Authors：

ZHAN Lili ¹ , LI Lan ¹ , ZHANG Li ¹ , XIAO Shan ¹ , LIANG Peng ² ,  HUANG Mingjun ¹

1. Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HUANG Mingjun, Email: huangmingjun@wchscu.cn

Keywords：

Day surgery; dietary management; fasting and fluid restriction; action research

DOI：

10.7507/1002-0179.202412156

Video：

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Objective To explore the practical effects of action research on the management of preoperative fasting and fluid restriction in day surgery patients. Methods A convenience sampling method was used to select day surgery patients who underwent day surgery at the Day Surgery Center of West China Hospital of Sichuan University between May 2022 and May 2024. According to the admission time, patients were divided into control group, first cycle group, and second cycle group. The effects of the preoperative fasting and fluid restriction management plan were observed based on the implementation of two rounds of action plans. Results A total of 567 patients were included. Among them, there were 186 cases in the control group, 190 cases in the first cycle group, and 191 cases in the second cycle group. There was no statistically significant difference in general information among the three groups of patients (P>0.05). After implementing the initiative to reduce preoperative fasting durations, the median preoperative fasting time for day surgery patients in the second cycle group was 4.41 (3.13, 6.12) hours, which represented a significant reduction compared to 13.72 (10.83, 16.40) hours in the control group and 6.42 (4.53, 9.60) hours in the first cycle group (P<0.05). Although the fasting duration did not significantly decrease among the three groups, the morning feeding rates for patients in the first and second cycle showed a slight increase compared to the control group. Conclusions Through the implementation of a preoperative fasting and fluid restriction management protocol, the preoperative fluid restriction duration for day surgery patients has been significantly reduced. This aligns with the principles of enhanced recovery after surgery. Moreover, the incidence of intraoperative aspiration and postoperative nausea and vomiting did not show a significant increase. Action research offers crucial theoretical and practical support for the efficient and scientific implementation of preoperative fasting and fluid restriction management.

Citation： ZHAN Lili, LI Lan, ZHANG Li, XIAO Shan, LIANG Peng, HUANG Mingjun. Research on shortening preoperative fasting and fluid restriction time in day surgery patients through process optimization based on action research method. West China Medical Journal, 2025, 40(10): 1629-1634. doi: 10.7507/1002-0179.202412156 Copy

1.	孙辉, 高嗣法, 孙佳璐, 等. 《医疗机构日间医疗质量管理暂行规定》的解读. 中国卫生质量管理, 2023, 30(5): 30-33.
2.	中国研究型医院学会微创外科学专业委员会. 日间腹腔镜胆囊切除术专家共识. 腹腔镜外科杂志, 2023, 28(8): 561-567, 573.
3.	Brown D, Xhaja A. Nursing Perspectives on Enhanced Recovery After Surgery. Surg Clin North Am, 2018, 98(6): 1211-1221.
4.	中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021 版). 中国实用外科杂志, 2021, 41(9): 961-992.
5.	Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev, 2003(4): CD004423.
6.	马正良, 黄宇光, 顾小萍, 等. 成人日间手术加速康复外科麻醉管理专家共识. 协和医学杂志, 2019, 10(6): 562-569.
7.	Abebe WA, Rukewe A, Bekele NA, et al. Preoperative fasting times in elective surgical patients at a referral hospital in Botswana. Pan Afr Med J, 2016, 23: 102.
8.	Abdullah Al Maqbali M. Preoperative fasting for elective surgery in a regional hospital in Oman. Br J Nurs, 2016, 25(14): 798-802.
9.	Zhu Q, Li Y, Deng Y, et al. Preoperative fasting guidelines: where are we now? findings from current practices in a tertiary hospital. J Perianesth Nurs, 2021, 36(4): 388-392.
10.	中华医学会麻醉学分会. 日间手术麻醉指南. 中华医学杂志, 2023, 103(43): 3462-3471.
11.	Sidik AI, Lishchuk A, Faybushevich AN, et al. Adherence to preoperative fasting guidelines in elective surgical patients. Cureus, 2024, 16(10): e71554.
12.	Paul PA, Joselyn AS, Pande PV, et al. 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.
13.	Dock-Nascimento DB, de Aguilar-Nascimento JE, Magalhaes Faria MS, et al. Evaluation of the effects of a preoperative 2-hour fast with maltodextrine and glutamine on insulin resistance, acute-phase response, nitrogen balance, and serum glutathione after laparoscopic cholecystectomy: a controlled randomized trial. JPEN J Parenter Enteral Nutr, 2012, 36(1): 43-52.
14.	Xu D, Zhu X, Xu Y, et al. Shortened preoperative fasting for prevention of complications associated with laparoscopic cholecystectomy: a meta-analysis. J Int Med Res, 2017, 45(1): 22-37.
15.	Shime N, Ono A, Chihara E, et al. Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals. J Anesth, 2005, 19(3): 187-192.
16.	周理, 齐晓轩, 韩艳芳, 等. 术前饮用碳水化合物饮料对老年胸科手术病人麻醉诱导前胃容量及围术期低血压的影响. 实用老年医学, 2023, 37(7): 671-675.
17.	Rüggeberg A, Meybohm P, Nickel EA. Preoperative fasting and the risk of pulmonary aspiration-a narrative review of historical concepts, physiological effects, and new perspectives. BJA Open, 2024, 10: 100282.
18.	Liang Y, Yan X, Liao Y. The effect of shortening the preoperative fasting period on patient comfort and gastrointestinal function after elective laparoscopic surgery. Am J Transl Res, 2021, 13(11): 13067-13075.
19.	Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg, 1995, 222(6): 728-734.
20.	de Andrade Gagheggi Ravanini G, Portari Filho PE, Abrantes Luna R, et al. Organic inflammatory response to reduced preoperative fasting time, with a carbohydrate and protein enriched solution; A randomized trial. Nutr Hosp, 2015, 32(2): 953-957.

1. 孙辉, 高嗣法, 孙佳璐, 等. 《医疗机构日间医疗质量管理暂行规定》的解读. 中国卫生质量管理, 2023, 30(5): 30-33.
2. 中国研究型医院学会微创外科学专业委员会. 日间腹腔镜胆囊切除术专家共识. 腹腔镜外科杂志, 2023, 28(8): 561-567, 573.
3. Brown D, Xhaja A. Nursing Perspectives on Enhanced Recovery After Surgery. Surg Clin North Am, 2018, 98(6): 1211-1221.
4. 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021 版). 中国实用外科杂志, 2021, 41(9): 961-992.
5. Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev, 2003(4): CD004423.
6. 马正良, 黄宇光, 顾小萍, 等. 成人日间手术加速康复外科麻醉管理专家共识. 协和医学杂志, 2019, 10(6): 562-569.
7. Abebe WA, Rukewe A, Bekele NA, et al. Preoperative fasting times in elective surgical patients at a referral hospital in Botswana. Pan Afr Med J, 2016, 23: 102.
8. Abdullah Al Maqbali M. Preoperative fasting for elective surgery in a regional hospital in Oman. Br J Nurs, 2016, 25(14): 798-802.
9. Zhu Q, Li Y, Deng Y, et al. Preoperative fasting guidelines: where are we now? findings from current practices in a tertiary hospital. J Perianesth Nurs, 2021, 36(4): 388-392.
10. 中华医学会麻醉学分会. 日间手术麻醉指南. 中华医学杂志, 2023, 103(43): 3462-3471.
11. Sidik AI, Lishchuk A, Faybushevich AN, et al. Adherence to preoperative fasting guidelines in elective surgical patients. Cureus, 2024, 16(10): e71554.
12. Paul PA, Joselyn AS, Pande PV, et al. 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.
13. Dock-Nascimento DB, de Aguilar-Nascimento JE, Magalhaes Faria MS, et al. Evaluation of the effects of a preoperative 2-hour fast with maltodextrine and glutamine on insulin resistance, acute-phase response, nitrogen balance, and serum glutathione after laparoscopic cholecystectomy: a controlled randomized trial. JPEN J Parenter Enteral Nutr, 2012, 36(1): 43-52.
14. Xu D, Zhu X, Xu Y, et al. Shortened preoperative fasting for prevention of complications associated with laparoscopic cholecystectomy: a meta-analysis. J Int Med Res, 2017, 45(1): 22-37.
15. Shime N, Ono A, Chihara E, et al. Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals. J Anesth, 2005, 19(3): 187-192.
16. 周理, 齐晓轩, 韩艳芳, 等. 术前饮用碳水化合物饮料对老年胸科手术病人麻醉诱导前胃容量及围术期低血压的影响. 实用老年医学, 2023, 37(7): 671-675.
17. Rüggeberg A, Meybohm P, Nickel EA. Preoperative fasting and the risk of pulmonary aspiration-a narrative review of historical concepts, physiological effects, and new perspectives. BJA Open, 2024, 10: 100282.
18. Liang Y, Yan X, Liao Y. The effect of shortening the preoperative fasting period on patient comfort and gastrointestinal function after elective laparoscopic surgery. Am J Transl Res, 2021, 13(11): 13067-13075.
19. Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg, 1995, 222(6): 728-734.
20. de Andrade Gagheggi Ravanini G, Portari Filho PE, Abrantes Luna R, et al. Organic inflammatory response to reduced preoperative fasting time, with a carbohydrate and protein enriched solution; A randomized trial. Nutr Hosp, 2015, 32(2): 953-957.

West China Medical Journal

Research on shortening preoperative fasting and fluid restriction time in day surgery patients through process optimization based on action research method

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