Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2022; 10(16): 5287-5296
Published online Jun 6, 2022. doi: 10.12998/wjcc.v10.i16.5287
Enhanced recovery after surgery strategy to shorten perioperative fasting in children undergoing non-gastrointestinal surgery: A prospective study
Yan Ying, Hong-Zhen Xu, Meng-Lan Han
Yan Ying, Hong-Zhen Xu, Meng-Lan Han, Department of General Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, Zhejiang Province, China
Author contributions: Ying Y and Xu HZ were responsible for the manuscript conceptualization, methodology, resources, software, and supervision; Ying Y and Han ML took charge of data curation, investigation, and project administration; Ying Y was responsible for funding acquisition and manuscript writing, reviewing, and editing; Han ML was responsible for formal analysis, validation, and visualization.
Supported by the Health Science and Technology Plan of Zhejiang Province in 2022, No. 2022KY867.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Children’s Hospital, Zhejiang University School of Medicine Institutional Review Board (Approval No. 2018-IRB-095).
Informed consent statement: All children and their guardians provided informed consent for the study.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Zhen Xu, MS, Department of General Surgery, Children's Hospital of Zhejiang University School of Medicine, No. 3333 Bingsheng Road, Binjiang Distract, Hangzhou 310052, Zhejiang Province, China. azureming@zju.edu.cn
Received: November 23, 2021
Peer-review started: November 23, 2021
First decision: March 23, 2022
Revised: April 2, 2022
Accepted: April 29, 2022
Article in press: April 29, 2022
Published online: June 6, 2022
Processing time: 190 Days and 20.2 Hours
Abstract
BACKGROUND

Enhanced recovery after surgery strategies are increasingly implemented to improve the management of surgical patients.

AIM

To evaluate the effects of new perioperative fasting protocols in children ≥ 3 mo of age undergoing non-gastrointestinal surgery.

METHODS

This prospective pilot study included children ≥ 3 mo of age undergoing non-gastrointestinal surgery at the Children’s Hospital (Zhejiang University School of Medicine) from January 2020 to June 2020. The children were divided into either a conventional group or an ERAS group according to whether they had been enrolled before or after the implementation of the new perioperative fasting strategy. The children in the conventional group were fasted using conventional strategies, while those in the ERAS group were given individualized fasting protocols preoperatively (6-h fasting for infant formula/non-human milk/solids, 4-h fasting for breast milk, and clear fluids allowed within 2 h of surgery) and postoperatively (food permitted from 1 h after surgery). Pre-operative and postoperative fasting times, pre-operative blood glucose, the incidence of postoperative thirst and hunger, the incidence of perioperative vomiting and aspiration, and the degree of satisfaction were evaluated.

RESULTS

The study included 303 patients (151 in the conventional group and 152 in the ERAS group). Compared with the conventional group, the ERAS group had a shorter pre-operative food fasting time [11.92 (4.00, 19.33) vs 13.00 (6.00, 20.28) h, P < 0.001), shorter preoperative liquid fasting time [3.00 (2.00, 7.50) vs 12.00 (3.00, 20.28) h, P < 0.001], higher preoperative blood glucose level [5.6 (4.2, 8.2) vs 5.1 (4.0, 7.4) mmol/L, P < 0.001], lower incidence of thirst (74.5% vs 15.3%, P < 0.001), shorter time to postoperative feeding [1.17 (0.33, 6.83) vs 6.00 (5.40, 9.20), P < 0.001], and greater satisfaction [7 (0, 10) vs 8 (5, 10), P < 0.001]. No children experienced perioperative aspiration. The incidences of hunger, perioperative vomiting, and fever were not significantly different between the two groups.

CONCLUSION

Optimizing fasting and clear fluid drinking before non-gastrointestinal surgery in children ≥ 3 mo of age is possible. It is safe and feasible to start early eating after evaluating the recovery from anesthesia and the swallowing function.

Keywords: Enhanced recovery after surgery, Fasting, Water deprivation, Pre-operative period, Postoperative period, Intraoperative complications, Postoperative complications

Core Tip: This study aimed to evaluate the effects of new perioperative fasting protocols in children > 3 mo of age undergoing non-gastrointestinal surgery. Through multi-disciplinary collaboration and information transformation, it is possible to optimize the fasting and clear fluid drinking process before non-gastrointestinal surgery in children > 3 mo of age. For children with non-gastrointestinal surgery, it is also safe and feasible to start early eating after evaluating the recovery from anesthesia and the swallowing function.