Comparative Analysis of the Efficacy of Traditional Verses ASA in Preoperative Fasting Guidelines in Elective Surgical Patients

Abstract

Background: Conventional “nil per os (NPO) after midnight” fasting remains common for elective surgery but may prolong discomfort and impair recovery, while American Society of Anesthesiologists (ASA) guidelines permit clear fluids up to 2 hours and a light meal up to 6 hours preoperatively without compromising safety. Objective: To compare patient comfort, postoperative recovery outcomes, and safety between ASA-guideline fasting and traditional NPO fasting in elective surgical patients undergoing general anesthesia. Methods: An analytical cross-sectional study was conducted at Nawaz Sharif Social Security Hospital, Lahore (January–April 2025) among 130 adults (≥18 years), ASA physical status I–III, undergoing elective orthopedic, general, urological, or gynecological surgery under general anesthesia. Patients followed either ASA fasting (n=65) or traditional NPO-after-midnight (n=65) per institutional practice. Preoperative hunger, thirst, and anxiety were measured within 30 minutes before transfer to the operating room using 0–10 numeric rating scales. Outcomes included intraoperative aspiration, postoperative nausea and vomiting (PONV; 0–3 scale), and length of hospital stay. Group comparisons used independent-samples tests and exact tests as appropriate (α=0.05). Results: ASA-guideline fasting significantly reduced hunger (1.88±1.42 vs 6.85±1.76), thirst (2.23±1.63 vs 7.35±1.58), and anxiety (1.55±1.31 vs 6.03±1.84) (all p<0.001). Any PONV occurred in 12.31% vs 24.62% (OR 0.43, 95% CI 0.19–0.97; p=0.042). Prolonged hospitalization (≥4 days) was 4.62% vs 55.38% (RR 0.17, 95% CI 0.06–0.44; p<0.001). Aspiration was rare (0.0% vs 1.54%; p=0.31). Conclusion: ASA-guideline fasting was associated with markedly improved preoperative comfort, reduced PONV, and shorter hospital stay without an observed increase in aspiration, supporting adoption of ASA-aligned fasting practices for elective surgery.