Effects of Prolonged Preoperative Fasting on Blood Glucose Levels in Pediatric Elective Surgeries: A Systematic Review and Meta-Analysis.

BACKGROUND

Albeit the numerous guidelines on pre-operative fasting in pediatric patients, clinical practice varies. Prolonged fasting can result in several complications, hypoglycemia being one of them. This systematic review and meta-analysis (SRMA) was conducted to assess the effect of prolonged pre-operative fasting on the incidence of hypoglycemia in pediatric patients posted for elective surgery.

MATERIALS AND

METHODS

Relevant studies (observational and randomized controlled studies [RCTs]) with fasting duration and incidence of hypoglycemia were identified from data sources (Medline, Scopus, Cochrane Library, Google Scholar) using a systematic search strategy. A pooled relative risk (RR) of hypoglycemia and ketosis due to prolonged fasting was calculated from the RCTs.

RESULTS

This SRMA included 42 studies (15 RCTs and 27 observational studies) involving 5121 patients. There was a wide variation in the definition of hypoglycemia, fasting duration, and incidence of hypoglycemia across the studies. The pooled RR for hypoglycemia was 2.0 (95% CI: 0.57-7.03, I2 = 0.00%, p = 0.28) in the prolonged fasting group compared to the non-prolonged fasting group. Although statistical significance was not reached, the direction and magnitude of the pooled effect suggest a clinically meaningful trend toward a lower risk of hypoglycemia with adherence to recommended fasting durations compared with prolonged fasting.

CONCLUSION

The findings of the review revealed the need for standardized outcome definitions and fasting protocols to enable comparisons across future studies. The meta-analysis revealed a variable relationship between fasting duration and hypoglycemia incidence. Structured interventions to facilitate the implementation of guidelines in clinical practice may mitigate the problem.