Evidence map›Paper›PMID 42421784›Full record

ArticleBJA open2026

Effect of a liberal fluid fasting policy before surgery on the incidence of aspiration: a single centre retrospective observational study.

Marije Marsman, Maarten Derksen, Marloes Veltcamp Helbach, Judith A R van Waes, Teus H Kappen, Evelien C van der Hout, Maurice E Pouw, Wilton A van Klei

Abstract read
In one paragraph

Article in BJA open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Marije MarsmanDepartment of Anaesthesiology and Intensive Care Medicine, University Medical Centre Utrecht, The Netherlands.
Maarten DerksenDepartment of Anaesthesiology Meander Medical Centre, Amersfoort, The Netherlands.
Marloes Veltcamp HelbachDepartment of Anaesthesiology and Intensive Care Medicine, University Medical Centre Utrecht, The Netherlands.
Judith A R van WaesDepartment of Anaesthesiology and Intensive Care Medicine, University Medical Centre Utrecht, The Netherlands.
Teus H KappenDepartment of Anaesthesiology and Intensive Care Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
Evelien C van der HoutDepartment of Pulmonology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Maurice E PouwDepartment of Anaesthesiology Meander Medical Centre, Amersfoort, The Netherlands.
Wilton A van KleiDepartment of Anesthesiology and Intensive Care Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: In adults undergoing anaesthetic procedures, a preoperative fasting duration of 2 h for clear fluids is advised to minimise pulmonary aspiration risk. This fasting duration is under debate, because a shorter duration has been shown to improve patient wellbeing and seems not markedly to increase the aspiration risk. Although some hospitals already have adopted such a policy, large-scale studies addressing safety of this strategy are lacking. Therefore, the primary aim of this study was to assess the incidence of aspiration after implementation of a liberal fluid fasting policy. Methods: This observational single-centre cohort study was performed in a Dutch tertiary referral hospital after implementation of a liberal fluid fasting policy and included adults undergoing elective and urgent procedures under anaesthesia. The primary outcome was pulmonary aspiration, defined as documented visualisation of gastric content in the tracheobronchial tree below the vocal cords as seen by laryngoscopy, bronchoscopy, after tracheal suctioning with or without signs of respiratory distress or both. Secondary outcomes were regurgitation (visualisation of gastric content in the oral cavity or pharynx) or aspiration pneumonia. Risk factors for aspiration were identified using logistic regression analysis. Results: Between June 2019 and February 2025, 56 995 patients were evaluated with a recognised aspiration incidence of 3.7 (95% confidence interval [CI] 2.4-5.6) per 10 000 patients. The incidence of regurgitation was 25 (95% CI 21-29) per 10 000, and aspiration pneumonia occurred in 2.1 (95% CI 1.2-3.7) per 10 000. Median fasting duration for clear fluids was 63 min (inter-quartile range 24-116 min). Conclusions: A liberal fasting policy for clear fluids before elective and urgent surgery in adults had a higher associated incidence of aspiration compared with the previously reported incidence using a standard 2-h fasting policy. Because a liberal fasting policy has been shown to improve patient wellbeing, this study could contribute to the discussion among patients and clinicians to balance the benefits and risks of such a liberal policy.

Indexed as

aspirationguidelinesimplementationliberalpreoperative fastingregurgitation

Identifiers

PMID42421784
PMCPMC13342875

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.