Society of American Gastrointestinal and Endoscopic Surgeons

View all recommendations from this society

August 27, 2020; Updated January 19, 2022.

Avoid unnecessary perioperative fasting for elective general surgical procedures.

Fasting after midnight used to be the standard of care before surgery, but there is adequate data that prolonged fasting is associated with increased perioperative insulin resistance, delayed recovery and poorer outcomes. Based on this, the American Society of Anesthesiologists and other organizations recommend refraining from solid food for 6–8 hours before surgery without increased aspiration or regurgitation in healthy patients.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The SAGES Quality, Outcomes and Safety (QOS) Committee appointed a task force (composed of active members of the committee) to develop a list of potential recommendations after being provided with information and links to the Choosing Wisely® website. This group compiled a list of recommendations which fit the criteria outlined by the ABIM Foundation. A literature search was performed to ensure the recommendations were evidence-based. The task force then distributed the list to the full membership of the SAGES QOS Committee, asking the members of the committee to rank the recommendations by level of importance and clinical relevance. The top recommendations were discussed by the committee and selected for inclusion in this list. The list was reviewed and approved by the SAGES Executive Committee and SAGES Board of Governors.


McLeod R, Fitzgerald W, Sarr M; for Members of the Evidence Based Reviews in Surgery Group. Canadian Association of General Surgeons and American College of Surgeons evidence based reviews in surgery. Preoperative fasting for adults to prevent perioperative complications. Can J Surg 2005;48:409-11

Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003:CD004423.

Maltby JR, Pytka S, Watson NC, et al. Drinking 300 mL of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients. Can J Anaesth. 2004;51:111–115.

“Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration,” Anesthesiology 2017; 126:376–93.