Validation of a novel patient satisfaction questionnaire for preoperative fasting in cataract surgery: a discrimination analysis



      Preoperative fasting is routinely performed to prevent anaesthesia-related pulmonary aspiration. To capture patients’ experiences with preoperative fasting, a 13-item questionnaire was developed and validated using Rasch analysis and shortened to 6 items. This extension study aims to assess this questionnaire's ability to discriminate between participants with a short versus long duration of fasting and early versus late day surgery.


      Single-centred cross-sectional study.


      Subjects were recruited via consecutive sampling of cataract patients on surgery day at Kensington Eye Institute in Toronto from February to December 2019.


      A validated preoperative fasting questionnaire was administered. Discriminative ability was assessed by comparing responses in patients scheduled for surgery in the morning (8:00 am–12:00 pm) versus afternoon (12:00 pm–3:30 pm) and fasting for short (≤8 hours) versus long (>8 hours) duration. Diagnostic ability of the 6-item questionnaire relative to the 13-item questionnaire was assessed with receiver operating characteristics curve analysis.


      A total of 164 patients (mean age 70.8 ± 10.0 years; 57% female) were included. Total scores of patients having surgery in the morning were greater (i.e., less fasting-related burden) than in the afternoon (p = 0.04). There was no significant difference in scores between patients fasting for a short versus long duration (p > 0.05). Receiver operating characteristics curve analysis showed excellent diagnostic ability of the 6-item questionnaire relative to the 13-item version (area under the curve = 0.964).


      The 6-item questionnaire for fasting-related burden has excellent discriminative ability between early versus late surgery patients. The time fasting while awake may be a more relevant predictor of fasting-related burden relative to the total duration of fasting.
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        • American Society of Anesthesiologists Task Force on Preoperative Fasting
        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.
        Anesthesiology. 2017; 126: 376-393
        • Robinson M
        • Davidson A.
        Aspiration under anesthesia: risk assessment and decision-making.
        BJA Education. 2014; 14: 171-175
        • Benington S
        • Severn A.
        Preventing aspiration and regurgitation.
        Anaesth Intens Care Med. 2007; 8: 368-372
        • Dobson G
        • Chong M
        • Chow L
        • et al.
        Guidelines to the practice of anesthesia–revised edition 2018.
        Can J Anaesth. 2017; 65: 76-104
        • Maltby JR.
        Fasting from midnight: the history behind the dogma.
        Best Pract Res Clin Anaesthesiol. 2006; 20: 363-378
        • Thompson J
        • Lakhani N.
        Prim Care. 2015; 42: 409-423
        • Hosoda Y
        • Kuriyama S
        • Jingami Y
        • et al.
        A comparison of patient pain and visual outcome using topical anesthesia versus regional anesthesia during cataract surgery.
        Clin Ophthalmol. 2016; 10: 1139-1144
        • Smith R.
        Cataract extraction without retrobulbar anaesthetic injection.
        Br J Ophthalmol. 1990; 74: 205-207
      1. Canadian Ophthalmological Society Cataract Surgery Clinical Practice Guideline Expert Committee. Canadian Ophthalmological Society evidence-based clinical practice guidelines for cataract surgery in the adult eye.
        Can J Ophthalmol. 2008; 41: S7-33
        • Lindley S.
        Is fasting required before cataract surgery?.
        Can J Ophthalmol. 2009; 44: 645-647
        • Popovic M
        • Schlenker MB
        • Goldshtein D
        • et al.
        Preoperative fasting for ambulatory cataract surgery: a systematic review.
        Can J Ophthalmol. 2019; 54: 145-149
        • Sanmugasunderam S
        • Khalfan A.
        Is fasting required before cataract surgery? A retrospective review.
        Can J Ophthalmol. 2009; 44: 655-656
        • Maltby JR
        • Hamilton RC.
        Preoperative fasting guidelines for cataract surgery under regional anaesthesia.
        Br J Anaesth. 1993; 71: 167
        • Kumar CM
        • Lawler GP.
        Acute dilatation of the stomach during general anaesthesia.
        Br J Anaesth. 1987; 59: 1192-1195
        • Koolwijk J
        • Fick M
        • Selles C
        • et al.
        Outpatient cataract surgery: incident and procedural risk analysis do not support current clinical ophthalmology guidelines.
        Ophthalmology. 2015; 122: 281-287
        • Guerrier G
        • Rothschild PR
        • Bonnet C
        • et al.
        Safety of low-dose propofol in non-fasted patients undergoing cataract surgery: a prospective cohort study.
        Br J Anaesth. 2019; 123: e526-e528
        • Steeds C
        • Mather SJ.
        Fasting regimens for regional ophthalmic anaesthesia: a survey of members of the British Ophthalmic Anaesthesia Society.
        Anaesthesia. 2001; 56: 638-642
        • Seet E
        • Kumar CM
        • Eke T
        • Joshi GP.
        Starving patients before cataract surgery under regional anesthesia: needed or not?.
        Anesth Analg. 2018; 127: 1448-1451
        • Popovic MM
        • Kalaichandran S
        • Kabanovski A
        • et al.
        Development and validation of a questionnaire assessing patient distress from preoperative fasting in cataract surgery.
        Ophthalmic Epidemiol. 2020; 28: 337-348
        • Bopp C
        • Hofer S
        • Klein A
        • et al.
        A liberal preoperative fasting regimen improves patient comfort and satisfaction with anesthesia care in day-stay minor surgery.
        Minerva Anestesiol. 2011; 77: 680-686
        • Hankins M.
        Questionnaire discrimination: (re)-introducing coefficient delta.
        BMC Med Res Methodo. 2007; 7: 19
        • Rosen RC
        • Cappelleri JC
        • Smith MD
        • et al.
        Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction.
        Int J Impot Res. 1999; 11: 319-326
        • Turró-Garriga O
        • Garre-Olmo J
        • López-Pousa S
        • et al.
        Abridged scale for the screening anosognosia in patients with dementia.
        J Geriatr Psychiatry Neurol. 2014; 27: 220-226
        • Badner NH
        • Nielson WR
        • Munk S
        • et al.
        Preoperative anxiety: detection and contributing factors.
        Can J Anaesth. 1990; 37: 444-447
        • Eberhart L
        • Aust H
        • Schuster M
        • et al.
        Preoperative anxiety in adults: a cross-sectional study on specific fears and risk factors.
        BMC Psychiatry. 2020; 20: 140
        • Mack C
        • Su Z
        • Westreich D.
        Managing missing data in patient registries: addendum to registries for evaluating patient outcomes.
        A user's guide,3rd ed. Agency for Healthcare Research and Quality (US), Rockville (MD)2018 ([Internet] Available at)