PREOPERATIVE FASTING AND POSTOPERATIVE RECOVERY IN GENERAL SURGERY: IMPACT OF MODERN PERIOPERATIVE CARE PROTOCOLS

Abstract

Introduction: Preoperative fasting is a traditional practice aimed at reducing the risk of regurgitation and pulmonary aspiration during anesthetic-surgical procedures. However, prolonged periods of food restriction can intensify the metabolic response to trauma and promote insulin resistance, dehydration, discomfort, and delayed postoperative recovery. Modern perioperative care protocols, such as Enhanced Recovery After Surgery (ERAS), propose safely shortening the fasting period and facilitating early nutritional recovery to achieve better clinical outcomes. Objective: To analyze scientific evidence regarding the impact of shortening preoperative fasting and modern perioperative care protocols on the recovery of patients undergoing general surgery. Methods: This is a narrative literature review conducted using the PubMed, SciELO, Virtual Health Library (VHL), and Cochrane Library databases. Articles published between 2019 and 2026 in Portuguese and English were considered, alongside national and international guidelines on perioperative care. The studies were analyzed qualitatively and descriptively. Results: Evidence demonstrated that protocols allowing clear liquids up to approximately two hours before anesthesia in appropriately selected patients are safe and reduce preoperative thirst, hunger, anxiety, and discomfort. Multimodal strategies—including shortened fasting, early postoperative feeding, adequate analgesia, and early mobilization—were associated with reduced insulin resistance, functional preservation, faster gastrointestinal recovery, and shorter hospital stays. However, recommendations must be individualized for patients with conditions associated with delayed gastric emptying or a higher risk of aspiration. Conclusion: Modernizing perioperative nutritional management is a key strategy for optimizing recovery in general surgery. Judiciously shortening the fasting period, when integrated into multimodal protocols, can enhance comfort, functional recovery, and reduce hospital stays without compromising safety, provided it is appropriately indicated. Its implementation requires institutional protocols, individualized assessment, and multiprofessional integration.