Pre-operative liquid fasting practices in twelve European countries : a prospective multicentre cohort study (Thirst study)

Abstract

BACKGROUND International guidelines recommend pre-operative clear liquid fasting for 2 h before anaesthesia. However, excessive fasting times remain widespread, potentially contributing to patient discomfort and adverse clinical outcomes.

OBJECTIVE To evaluate current pre-operative liquid fasting practices among adults undergoing elective procedures across multiple European centres.

DESIGN Prospective, observational, multicentre study.

SETTING Forty-six centres in 12 European countries, conducted between November and December 2024.

PATIENTS A total of 5100 adults undergoing elective surgery or interventional procedures under general anaesthesia, regional anaesthesia or sedation.

MAIN OUTCOME MEASURES Self-reported duration of pre-operative liquid fasting; incidence of prolonged fasting duration (defined as liquid fasting times of more than 4 h). Median [IQR] fasting time was calculated, with subgroup analyses by country and procedure type.

RESULTS The median [IQR] pre-operative liquid fasting time was 12 [10 to 14.6] h. Only 4% of patients consumed clear liquids within 2 to 4 h, and 0.8% within 2 h. Fasting durations were consistently prolonged across most countries and procedures, except for notably shorter times in Albania. Overall, 95% of patients fasted beyond 4 h.

CONCLUSIONS Excessive pre-operative liquid fasting remains highly prevalent across Europe, with poor implementation of established guidelines. These findings underscore the need for educational, institutional, and quality improvement interventions to align clinical practice with evidence-based recommendations and enhance patient-centred care.