ArticleNutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition2025
Drink lemonade! Implementation of drinking 2 h before elective orthopedic surgery to reduce prolonged fasting.
Article in Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Peri-operative fasting in adults: an international, multidisciplinary consensus statement.Anaesthesia · 2026Pooled it
- True Preoperative Liquid Fasting in Romania-A Secondary Analysis of the Thirst Study.Nutrients · 2026Observational
- Drink lemonade! Implementation of drinking 2 h before elective orthopedic surgery to reduce prolonged fasting.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2025Article
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6 authors.
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Abstract
backgroundProlonged fasting before surgery remains common despite guidelines recommending liquid fasting for 2 h and solid fasting for 6 h preoperatively. Consuming carbohydrate-rich drinks until 2 h before surgery improves patient well-being and reduces postoperative complications and insulin resistance. Given the persistence of implementation barriers, including logistical challenges and insufficient patient education, this study aimed to implement drinking up to 2 h before elective orthopedic surgery.
methodsThe Grol and Wensing implementation approached was followed in a before-after study conducted at a Dutch academic orthopedic ward (April 2023 to May 2024), after approval by the Scientific Ethical Committee. Current practices and barriers were assessed, and tailored strategies were developed using implementation theory and taxonomies to develop implementation strategies for the identified factors, followed by integration and evaluation.
resultsImplementation included dissemination, patient-oriented, organizational, educational, and risk prevention strategies. A total of 39 patients participated in the initial analysis and 48 patients participated in the evaluation. Preoperative fasting from liquids significantly reduced from 8:20 h (IQR: 4:42-12:19 h) to 4:38 h (IQR: 2:58-6:12) by informing patients about the importance of drinking up to 2 h before surgery and to 2:45 h (IQR: 2:21-3:26) by facilitating drinking lemonade after admission when surgery would start in ≥2 h. Patients' comfort improved regarding thirst, whereas no effect was found for other symptoms. Adverse events, including postponement of surgeries and pulmonary aspirations, during surgery did not occur while accepting >1 h of fasting at the start of surgery.
conclusionsScalable implementation strategies for patient education on fasting and coordinated provision of lemonade reduced fasting duration among elective orthopedic patients.
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