• Posted October 21, 2024

Too Much Fasting in Hospital Could Have Downside for Orthopedic Surgery Patients

The repeated fasting required for multiple surgeries in a row can slow a patient’s recovery and increase the risk of death, a new study warns.

Surgical patients are asked to not eat after midnight prior to their procedure, to reduce the risk that they’ll throw up during general anesthesia and deep sedation.

But folks having multiple surgeries during the same hospital stay are more likely to suffer malnutrition as a result of all this fasting, researchers found.

“Our research determined that repeated fasting in hospitalized patients having multiple orthopedic surgeries over days or weeks increases the risk for protein-calorie malnutrition, leading to longer hospital stays, slower recovery and higher health care costs,” said lead researcher Ivie Izekor, a fourth-year medical student at Texas A&M College of Medicine.

For the study, researchers analyzed data on nearly 28.5 million patients who had any type of orthopedic surgery in a hospital between 2016 and 2019.

Of those patients, more than 1.8 million were diagnosed with malnutrition after admission.

Patients diagnosed with malnutrition had gone through more surgeries during their hospital stay -- an average of 2.3 surgeries per stay, compared with nearly 1.6 for those who didn’t become malnourished.

Malnourished patients were 15% more likely to die, and their risk of death increased with more surgeries, researchers found.

Malnourished patients typically died from infection, complications from poor wound healing or general frailty exacerbated by a lack of nutrition.

They also racked up higher hospital costs -- an average $98,000 versus $48,000 for those not malnourished -- and longer hospital stays, an average nine days versus four days.

The findings were presented Saturday at the American Society of Anesthesiologists annual meeting in Philadelphia. Such results should be considered preliminary until published in a peer-reviewed journal.

To prevent malnutrition, the researchers suggested that patients who need multiple surgeries during a hospital stay receive personalized nutritional support.

This might include dietary assessments, nutritional supplementation and monitoring nutritional status to help facilitate faster recovery and reduce the number of complications.

“The combined effects of repeated fasting and surgical stress can compromise nutritional status, regardless of the type of surgery, and it is likely our findings would hold true for patients undergoing multiple surgeries of any type,” said senior researcher Dr. George Williams, professor and vice chair of critical care medicine with McGovern Medical School at UT Health in Houston, TX. 

“However, it may be more challenging to assess the cause-and-effect relationship in gastrointestinal surgeries due to their direct impact on the digestive system,” Williams added in a meeting news release.

More information

The University of Texas MD Anderson Cancer Center has more about fasting before anesthesia.

SOURCE: American Society of Anesthesiologists, news release, Oct. 19, 2024