A cross-sectional study of fasting practices among paediatric elective surgery patients at Chris Hani Baragwanath Academic Hospital.

Background: All patients are required to fast preoperatively to avoid the risk of pulmonary complications and, in some cases, mortality. Several guidelines have been published worldwide to guide the fasting practices of paediatric patients. Although guidelines are in place, it is essential to study actual fasting practices to determine if they align with current recommendations. Methods: This was a cross-sectional study of fasting practices among elective pediatric patients over ten weeks at Chris Hani Baragwanath Academic Hospital (CHBAH), South Africa. Data collected included paediatric elective surgical patients from various surgical specialities, prescribed fasting times for solids and clear fluids, actual fasting times for solids and clear fluids, fasting glucose levels, and timings of anaesthesia commencement and conclusion. The data were analysed using descriptive statistics. Results: The dataset included 100 paediatric patients scheduled for elective surgery at CHBAH. Patient ages ranged from infancy to 17 years. Median prescribed fasting times were 9.6 hours for solids and 9.0 clear fluids. However, median actual fasting times were 14.8 hours for solids and 13.7 hours for clear fluids, exceeding recommendations (p<0.001). Only 2.0% of patients complied with the guidelines for clear fluids; there was zero compliance for solids. Guidelines approximated breast milk and formula fasting times but showed wide variability. Eighteen per cent of patients were hypoglycaemic preoperatively. Conclusion: This study revealed widespread over-fasting among paediatric surgical patients at CHBAH, with actual fasting durations far exceeding prescribed times and international guidelines, particularly for clear fluids and solids. These findings indicate a systemic disconnect between prescription and practice, suggesting a need for institutional changes to align perioperative care with best practice standards. Recommendations: We recommend implementation of updated institutional fasting guidelines that align with international best practice (6:4:1 rule) and allow clear fluids one hour before induction of anaesthesia.