How long are tube feeds continued before a patient is scheduled for surgery in the Operating Room (OR)?

From the Guidelines

Tube feeds should be stopped at least 6-8 hours before a patient is scheduled to go into the OR to minimize the risk of aspiration during anesthesia induction. This recommendation is based on general principles of perioperative care, although specific guidelines on the duration of tube feed cessation before surgery are not directly addressed in the provided evidence 1. The ESPEN guideline on clinical nutrition in surgery emphasizes the importance of early tube feeding in certain patient groups, such as those undergoing major head and neck or gastrointestinal surgery for cancer, patients with severe trauma, and those with obvious malnutrition at the time of surgery 1. However, the guideline does not provide specific recommendations on when to stop tube feeds before surgery.

In clinical practice, the decision on when to stop tube feeds before surgery is often based on the type of surgery, the patient's underlying condition, and the anesthesia plan. For patients receiving continuous enteral nutrition, stopping the feeds 6-8 hours before surgery is a common practice to allow for adequate gastric emptying and reduce the risk of aspiration. Clear liquids administered through the tube can typically be stopped 2 hours before surgery. It's crucial to consider individual patient factors, such as gastroparesis or other gastrointestinal motility disorders, when determining the optimal fasting period. After surgery, tube feeds can usually be restarted once the patient is fully awake, has stable vital signs, and shows evidence of bowel function, typically within 24-48 hours post-procedure.

Key considerations in the decision-making process include:

• The type of surgery and anesthesia planned
• The patient's underlying medical conditions and nutritional status
• The presence of any gastrointestinal motility disorders
• Institutional protocols and guidelines for perioperative care
• The need to balance the risk of aspiration with the importance of maintaining adequate nutrition in the perioperative period, as emphasized by the ESPEN guideline 1.

From the Research

Tube Feeding Duration Before OR

• The duration for which tube feeds should be kept going before a patient is scheduled to go into the OR is not strictly defined, but studies suggest that tube feedings can be continued until the time of surgery in certain cases 2, 3.
• A study published in 2018 found that tracheostomy without tube feed interruption is feasible and reduces malnutrition, with no increase in pulmonary complications or mortality in the fed patients 2.
• Another study from 1999 found that patients with jejunostomy tubes can be fed safely until the time of surgery, with no incidence of aspiration, and that continuing tube feedings until surgery reduces the risk of malnutrition 3.
• The decision to stop or continue tube feedings before surgery should be made on a case-by-case basis, taking into account the individual patient's needs and medical condition.

Key Findings

• Tube feedings can be continued until the time of surgery in certain cases, without increasing the risk of pulmonary complications or mortality 2, 3.
• Continuing tube feedings until surgery can reduce the risk of malnutrition and decrease the duration of hospital stay 2, 3.
• The use of prokinetic agents, such as metoclopramide and erythromycin, can enhance gastric emptying and reduce the risk of gastroparesis in critically ill patients 4, 5, 6.

Considerations

• The decision to stop or continue tube feedings before surgery should be made in consultation with the patient's healthcare team, taking into account the individual patient's needs and medical condition.
• The use of prokinetic agents and other interventions to enhance gastric emptying should be considered in patients at risk of gastroparesis or malnutrition 4, 5, 6.