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: = 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.