Study finds no link between long-standing preprocedural fasting and aspiration pneumonia risk

Editor's Note

Loosening fasting policies before surgery does not increase the risk of post-surgical aspiration, also known as aspiration pneumonia, according to a systematic review and meta-analysis published in the journal Surgery in August 2025.

The researchers analyzed 17 studies published between 2016 and 2023, including randomized clinical trials and observational studies. Nine of these directly reported aspiration outcomes. The primary outcome was witnessed aspiration, while secondary measures included gastric volume and pH. According to the article, aspiration events were rare across all studies.

In experimental groups with more liberal fasting regimens, 4 of 801 patients experienced aspiration (0.50%), compared with 7 of 990 patients in standard-fasting control groups (0.71%). Statistical analysis found no significant association between fasting duration and aspiration risk, with an odds ratio of 1.17 and a confidence interval spanning wide and non-significant bounds. Trial sequential analysis further indicated little likelihood that future studies would alter this conclusion.

The outlet reports while most prior literature focused on surrogate markers such as gastric volume and acidity, these measures have never been shown to correlate with actual aspiration events in humans. By contrast, the present analysis examined aspiration itself as the outcome, providing more clinically meaningful evidence. The article concludes preprocedural fasting policies may not meaningfully reduce aspiration risk. The authors suggest “liberalized” approaches could be considered and bedside gastric ultrasound may provide a more practical and individualized assessment of aspiration risk than fixed fasting intervals.