ASA: Repeated Fasting Increases Malnutrition Risk in Patients Undergoing Multiple Surgeries

A Study by the American Society of Anesthesiologists Highlights the Dangers of Prolonged Fasting

Malnutrition: A Silent Killer in the Operating Room

Malnutrition, often overlooked but always present, can significantly impact the recovery process of patients undergoing multiple surgeries. A recent study by the American Society of Anesthesiologists (ASA) has shed light on the alarming risk of malnutrition among patients who are subjected to repeated or prolonged fasting periods during their hospital stays. This critical issue affects not just orthopedic surgery patients but also those undergoing any type of multiple surgeries, and it underscores the need for personalized nutritional support to ensure better outcomes.

The Study: Unveiling the Risks

The study, which analyzed the records of over 28 million patients who had orthopedic surgery between 2016 and 2019, revealed a disturbing trend. About 6% of these patients were diagnosed with malnutrition after admission, and this condition significantly increased their risk of mortality, hospital stays, and healthcare costs.

Key Findings:

• Malnutrition Rates: 6% of patients were diagnosed with malnutrition.
• Increased Mortality: Malnourished patients were at least 15% more likely to die.
• Prolonged Stays: Malnourished patients had an average hospital stay of 9.1 days compared to 4.3 days for non-malnourished patients.
• Higher Costs: The average hospital bill for malnourished patients was $98,000, while it was $48,000 for non-malnourished patients.

The Dangers of Prolonged Fasting

Prolonged fasting, which is often necessary to reduce the risk of inhaling stomach contents during general anesthesia, is a common practice in hospitals. However, this practice can have severe consequences for patients undergoing multiple surgeries. The longer a patient fasts, the higher the risk of developing protein-calorie malnutrition, which can slow down recovery and increase the risk of death.

Why Fasting is Necessary:

• Regurgitation Risk: Food or liquid in the stomach increases the risk of regurgitation and aspiration during anesthesia.
• Precautions: Patients are usually advised to fast for at least eight hours before surgery and only consume clear liquids up to two hours beforehand.

The Impact on Patient Outcomes

Malnutrition can have devastating effects on patient outcomes. The study found that malnourished patients were more likely to experience complications such as infections, poor wound healing, and general frailty. These conditions can significantly prolong hospital stays and increase healthcare costs.

Complications of Malnutrition:

• Infections: Malnutrition weakens the immune system, making patients more susceptible to infections.
• Poor Wound Healing: Adequate nutrition is essential for proper wound healing. Malnutrition can lead to delayed or incomplete healing.
• General Frailty: Malnutrition can cause a general decline in health, making patients more vulnerable to various health issues.

Personalized Nutrition Support: The Way Forward

To mitigate the risks associated with malnutrition, the ASA recommends personalized nutrition support for patients undergoing multiple surgeries. This support can include dietary assessments by a dietitian, nutritional supplementation, and regular monitoring of nutritional status.

Recommendations:

• Dietary Assessments: Patients should undergo a thorough dietary assessment to identify their nutritional needs.
• Nutritional Supplementation: Patients who are at risk of malnutrition should receive nutritional supplements to ensure they are getting the necessary nutrients.
• Monitoring Nutritional Status: Regular monitoring of a patient’s nutritional status can help in early detection of malnutrition and prompt intervention.

A Call to Action

The study by the ASA highlights the urgent need for a change in clinical practice. While fasting is essential for patient safety during surgery, modifications to this practice are necessary for patients at risk of malnourishment. This includes older patients, those with chronic illnesses, and those with limited access to adequate nutrition before surgery.

At-Risk Patients:

• Age: Patients older than 65 years.
• Chronic Illnesses: Patients with conditions like diabetes or congestive heart failure.
• Socioeconomic Factors: Patients with limited access to adequate nutrition prior to surgery.

Conclusion

Repeated fasting increases the risk of malnutrition in patients undergoing multiple surgeries, leading to longer hospital stays, higher healthcare costs, and a higher risk of death. The study by the ASA underscores the importance of personalized nutrition support to mitigate these risks. By implementing these strategies, healthcare providers can significantly improve patient outcomes and ensure that patients receive the care they need to recover effectively from their surgeries.

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References

• https://www.beckershospitalreview.com/patient-safety-outcomes/repeat-fasting-dangerous-for-orthopedic-surgeries-study-finds.html
• https://www.asahq.org/about-asa/newsroom/news-releases/2024/10/prolonged-fasting-for-multiple-orthopedic-surgeries-raises-risk-of-malnutrition