Excessive preoperative liquid fasting remains widespread across Europe

Researchers from the University of Malta have led a large prospective multicentre European study examining preoperative liquid fasting practices in adults undergoing elective procedures under anaesthesia.

Current international guidelines recommend that clear liquids may be safely consumed up to two hours before anaesthesia. Despite this, excessive fasting remains common in routine clinical practice. The study, published in the European Journal of Anaesthesiology, evaluated real-world fasting practices across 46 centres in 12 European countries between November and December 2024.

A total of 5,100 adult patients undergoing elective surgical or interventional procedures under general anaesthesia, regional anaesthesia or sedation were included. Patients self-reported the timing of their last clear liquid intake on the day of surgery. The median liquid fasting time was 12 hours, with 95% of patients fasting for more than four hours. Only 0.8% of patients reported consuming clear liquids within the recommended two-hour window.

Prolonged fasting was observed consistently across most participating countries and procedural categories. Patients undergoing non-operating room anaesthesia experienced the longest fasting durations, while ophthalmic procedures were associated with shorter fasting times. Albania was a notable outlier, demonstrating significantly shorter fasting durations, reflecting more liberal local fasting practices.

Excessive preoperative fasting has been associated with patient discomfort, dehydration, metabolic stress and adverse perioperative outcomes, without evidence of improved safety. The findings of this University of Malta–led study highlight a persistent gap between evidence-based guidelines and routine clinical practice across Europe.

The study was endorsed by the European Society of Anaesthesiology and Intensive Care and received ethical approval from the Faculty Research Ethics Committee of the University of Malta. These results underline the need for targeted educational initiatives, institutional policy reform and structured quality improvement strategies to improve adherence to fasting guidelines and enhance patient-centred perioperative care.