BJA open · 2026
The relationship between patient-reported hunger and gastric contents in adult patients with acute surgical abdominal pathology: exploratory prospective observational study.
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Morton Fraser, Ballard Emma, Van de Putte Peter, Peters Nathan, Woods Christine, Eley Victoria
Аннотация
BACKGROUND: Patient-reported hunger has been used to infer an empty stomach preoperatively. We hypothesised that hungry patients with acute abdominal pathology would be considered 'low risk' of aspiration when assessed by gastric ultrasound. The primary aim was to determine whether patient-reported hunger was associated with gastric ultrasound findings of aspiration risk in patients with acute abdominal pathology.
METHODS: In this exploratory prospective observational study, we recruited adults awaiting emergency abdominal surgery without additional risk factors for gastroparesis. Participants self-completed a questionnaire, and then a blinded operator performed a standardised gastric ultrasound. Hunger was assessed using three question formats (binary, ordinal, or numerical rating scale). A 'high risk' stomach was defined as the presence of gastric solids, Perlas grade 2, cross-sectional area >9.9 cm2, or gastric volume (clear fluid) >1.5 ml kg-1.
RESULTS: One hundred patients were enrolled (median age=32 years, 61% female, mean BMI=28 kg m-2) across two hospitals in Brisbane, Australia from April 2022 to May 2024. Fifty-nine (59%) had appendicitis, and 35 (35%) had cholecystitis. The antrum was visualised in 96 patients, of whom 33 (34%) were considered high aspiration risk. Forty-four (70%) of the 'low risk' patients were hungry compared with 22 (67%) of the 'high risk' patients (P=0.75). For the primary outcome, there was a mean hunger rating of 4.6 (95% confidence interval [CI]=4.1-5.2) and no significant difference between aspiration risk groups (mean difference = -0.75 [95% CI= -1.96 to 0.45]). For secondary outcomes, we demonstrated a weak negative correlation between gastric volume per kilogram and rating of hunger (rs = -0.137 [95% CI= -0.402 to 0.128]) with no discernible trend.
CONCLUSIONS: In this exploratory study, no meaningful relationship between hunger and aspiration risk using gastric ultrasound could be identified. Our results require confirmation.
METHODS: In this exploratory prospective observational study, we recruited adults awaiting emergency abdominal surgery without additional risk factors for gastroparesis. Participants self-completed a questionnaire, and then a blinded operator performed a standardised gastric ultrasound. Hunger was assessed using three question formats (binary, ordinal, or numerical rating scale). A 'high risk' stomach was defined as the presence of gastric solids, Perlas grade 2, cross-sectional area >9.9 cm2, or gastric volume (clear fluid) >1.5 ml kg-1.
RESULTS: One hundred patients were enrolled (median age=32 years, 61% female, mean BMI=28 kg m-2) across two hospitals in Brisbane, Australia from April 2022 to May 2024. Fifty-nine (59%) had appendicitis, and 35 (35%) had cholecystitis. The antrum was visualised in 96 patients, of whom 33 (34%) were considered high aspiration risk. Forty-four (70%) of the 'low risk' patients were hungry compared with 22 (67%) of the 'high risk' patients (P=0.75). For the primary outcome, there was a mean hunger rating of 4.6 (95% confidence interval [CI]=4.1-5.2) and no significant difference between aspiration risk groups (mean difference = -0.75 [95% CI= -1.96 to 0.45]). For secondary outcomes, we demonstrated a weak negative correlation between gastric volume per kilogram and rating of hunger (rs = -0.137 [95% CI= -0.402 to 0.128]) with no discernible trend.
CONCLUSIONS: In this exploratory study, no meaningful relationship between hunger and aspiration risk using gastric ultrasound could be identified. Our results require confirmation.