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Liquid Fasting Before an Operation: Reducing Risk, Improving Care

Overview

Patient safety is not only about preventing major adverse events. It is also about questioning avoidable harm that can become embedded in everyday healthcare routines.

Despite significant evidence, many patients continue to experience prolonged “nothing after midnight” practices before an operation. This can lead to unnecessary fasting from clear liquids for 12 hours or more. Such practices may cause distress, thirst, hunger, anxiety, dehydration, delayed recovery, and potential harm, with no demonstrated clinical benefit.

Following the recent publication of the International Multidisciplinary Consensus Statement on Pre-operative Liquid Fasting, developed through a rigorous Delphi process, the World Patients Alliance (WPA) and the European Patient Safety Foundation (EUPSF) believe it is important to bring current fasting practices into open discussion. When routine practices affect patients without a clear clinical rationale, they should be examined through evidence, clinical experience, and the patient perspective.

With this aim, WPA and EUPSF are organizing a collaborative webinar titled “Liquid Fasting Before an Operation: Reducing Risk, Improving Care” on July 9, 2026, at 9:00 AM EST.

The webinar will place consensus recommendations, real-world clinical practice, and patient experience into dialogue. Participants will learn how the consensus group approached clear-liquid fasting, hear patient stories that highlight the physical and psychological toll of prolonged fasting, and engage with a multi-stakeholder panel on why long-standing traditions persist in perioperative care.

The discussion will also explore what it would take to question and improve these practices in ways that support safer, more respectful, and more patient-centered care before surgery.

We invite healthcare professionals, hospital administrators, patient advocates, patient safety leaders, and other stakeholders to join this important discussion on rethinking perioperative care and strengthening attention to patient experience before an operation.

Agenda

Welcome and Introductions

Andrew Spiegel, Chair, WPA

Presentations:

– From 'Nothing After Midnight' to Evidence-Based Care: The New International Consensus on Pre-operative Liquid Fasting

Dr. Anne Rüggeberg (Germany), Anaesthesiologist and Lead of the Fasting Card Project

Patient Perspective: Real-World Examples from Different Regions

Helen Haskell, Chair, WPA Patient Safety & Quality Council

Panel Discussion: Solutions and Next Steps

Moderator: Helen Haskell, World Patient Alliance

Panelists

– Anne Rüggeberg (Germany), Anaesthesiologist, Lead of Consensus Statement

– Anne Marie Camilleri Podesta (Malta), Consultant in Anaesthesia and Intensive care, Mater Dei Hospital, Malta

– Doina Carmen Mazilu (Romania), EUPSF Board member and Vice-President of The Order of Nurses, Midwives and Medical Assistants in Romania

– Jolanta Bilinska Founding Board Director WPA

– Prof. Maria Pilar Astier Peña | WONCA President Elect | World Organization of Family Doctors (WONCA)

Q&A

Closing Remarks

Mrs. Mirka Cikkelova, General Secretary, EUPSF

Dr. Anne Rüggeberg

Anne Rüggeberg, an anaesthetist and intensive care and emergency doctor. Completed her training at the Charité in Berlin. Since 2019, she has been working on the fasting protocol 'unrestricted drinking before surgery with fasting cards'.

Mrs. Doina Carmen Mazilu

Doina Carmen Mazilu, RN, BScN, MSc, PhD, is a senior lecturer at the "Carol Davila" University of Medicine and Pharmacy in Bucharest, Romania. Her academic journey includes a PhD in medical sciences, two master's degrees (in public health management and medical law), and a robust continuous professional training portfolio in leadership, communication, quality management, and healthcare research. Her professional background aligns seamlessly with the themes of patient safety. As the director of the Romanian Centre for Nursing Research, she has led numerous projects to implement evidence-based practices in clinical settings and improve the quality and safety of care. Her work includes developing professional guidelines and spearheading training initiatives for nurses and midwives, with a strong focus on integrating research into practice. In addition to her role as Board Member of European Patient Safety Foundation (EUPSF), she is also Vice President of the Order of Nurses, Midwives, and Medical Assistants in Romania, and President of the Bucharest Branch of the Order of Nurses, Midwives, and Medical Assistants in Romania (OAMGMAMR). These positions allow her to lead impactful national and international projects aimed at improving patient and professional safety.

Mirka Cikkelova

Mirka Cikkelova is the General Secretary of the European Patient Safety Foundation (EUPSF), an independent foundation based in Brussels, Belgium. With a background in management and extensive experience in project coordination, she leads EUPSF’s efforts to unite experts and organisations in advancing patient safety across Europe.

Jolanta Bilińska

Jolanta Bilińska –Director of Development and Social Communication at City Medical Centre dr. K. Jonscher in Lodz, lecturer at High School for Nurses in Kalisz, before at National Health Fund- Lodz, Head of the Department of International Cooperation. Jolanta Bilińska has M.A. in Clinical Psychology. She used to diagnose hospitalised children and teenagers with personal disorders. In early 90”s she started working for regional newspaper – DziennikŁódzki. She published almost 2000 articles concerning medical issues and politics. She was mostly interested in matters relating to patients’ rights and the way they are observed in health care system. She also raised patients’ awareness of the health care system. Since the year 2004 she has performed the function of coordinator concerning European Union in National Health FundinŁódź. Since 2005 she has been the champion leader in World Alliance for Patient Safety. In 2006 she established Patient Safety Foundation. Its main aim is to promote safety measures in health service as well as to involve patients in the process of treatment, The foundation cooperates with the Ministry of Health, WHO officer and another non-governmental organization which are regarding patients’ matters. She is an expert in Public Health from 2009,she was also a IAPO chair of the board from 2015– 2018 (International Alliance of Patients Organizations).

Dr. Anne Marie Camilleri Podesta

Dr. Anne Marie Camilleri Podesta is a Board Member of the European Society of Anaesthesiology and Intensive Care (ESAIC) and Chair of its National Anaesthesiologists Societies Committee (NASC). In these roles, she facilitates collaboration and harmonization among national societies of anaesthesiologists across Europe and contributes to the society’s strategic direction. She also serves as an EDAIC Part 2 Examiner and is an active member of several ESAIC committees, including the Sustainability, Patient Safety and Quality, Guideline, and Train the Trainer Committees. At the national level, Dr. Camilleri Podesta is President of the Association of Anaesthesiologists and Intensivists of Malta (AAIM), where she contributes to the Specialist Accreditation and Training Committees and organizes the annual Recognition and Acute Care Treatment (ReACT) course. She also chaired Malta’s first international anaesthesia conference, Focus on the High Risk Patient, held in February 2025, and organized a Research Masterclass in Malta. Dr. Camilleri Podesta is a Consultant in Anaesthesia and Intensive Care at Mater Dei Hospital, Malta. She leads Research and Audit in Anaesthesia, serves as a Foundation Training Programme Director and Educational Supervisor for Malta’s Foundation Programme, and lectures as a Visiting Lecturer at the University of Malta. She is also a tutor with Queen Mary University of London. An Educator for the European Resuscitation Council, she acts as Director and Instructor for multiple life support courses, including the Generic Instructor Course, Advanced Life Support, Immediate Life Support, and European Paediatric Life Support courses. She has taught on ERC courses in Sweden, Finland, the United Kingdom, the Czech Republic, and Sri Lanka. Dr. Camilleri Podesta has a particular research interest in fasting and hydration. She has authored several publications on these topics and was Principal Investigator of the international THIRST study, a multicentre European study investigating contemporary fasting practices.

Prof. María Pilar Astier Peña

Prof. María Pilar Astier Peña, MD, PhD, is the President-Elect of WONCA (World Organization of Family Doctors, 2025–2027) and a leading international expert in patient safety, clinical ethics, and healthcare quality. Based in Zaragoza, Spain, she balances active clinical practice as a family doctor at the Universitas Health Center with her role as a Permanent Professor at the University of Zaragoza, where her academic focus centers on improving clinical reasoning, patient safety, family medicine, and bioethics. Throughout her career, Professor Astier Peña has bridged the gap between community-based primary care and macro-level health policy. She regularly serves as an external advisor on healthcare quality and patient safety for major international bodies, including the World Health Organization (WHO) and the OECD. Nationally, she has been a key technical advisor to the Spanish Ministry of Health, shaping Spain’s National Patient Safety Strategies (2015–2020 and 2025–2035) as well as the National Quality Plan (2026–2036). She also is an active member in scientific societies like Spanish Society for Family and Community Medicine (Semfyc), Spanish Society for Healthcare Quality (SECA) and WONCA Europe and WONCA World as chair and member of the healthcare quality and patient safety working parties. With a profound research background spanning primary health care models and organizational challenges, clinical overdiagnosis, vulnerable populations, complex care pathways for polymedicated elderly patients, and healthcare quality systems, including prior executive experience in hospital management in Spain. Professor Astier Peña brings a vital, holistic primary care perspective to the perioperative discussion, advocating for seamless, risk-stratified, and patient-centered clinical standards.

Helen Haskell

Since the medical error death of her young son Lewis in 2000, Helen Haskell has worked to bring the patient voice to healthcare safety and quality. Helen is president of the American nonprofit patient organizations Mothers Against Medical Error and Consumers Advancing Patient Safety and is an Institute for Healthcare Improvement senior fellow. She is Chair of WPA Patient Safety and Quality Council and former co-chair of the WHO Patients for Patient Safety Advisory Group and a recently retired board member of the Accreditation Council for Graduate Medical Education and the Institute for Healthcare Improvement. She is a member of the board of directors of the International Society for Rapid Response Systems, the Patient Safety Action Network and is on the steering committee of Consumers United for Evidence-Based Medicine. She serves on many other boards and committees, including quality and safety committees at the National Quality Forum, AHRQ, and the Center for Medicare and Medicaid Services. She was a winner of Consumer Reports’ first National Excellence in Advocacy award in 2011 and was named by Modern Healthcare magazine as one of the “100 Most Powerful People in Healthcare” in 2009 and by Becker’s Hospital Review as one of 50 leaders in patient safety in 2015, 2016, and 2017. She has written numerous journal articles and patient educational materials on patient safety and patient engagement and is co-editor of an interprofessional textbook using patient narrative to teach patient safety and professional competencies. She has been featured in dozens of articles and videos on patient safety, including Transparent Health’s Lewis Blackman Story, shown in hospitals and medical and nursing schools across the world.

Date

Jul 09 2026

Time

9:00 am - 10:30 am

2 Comments

Stella Maris Ponce

27 June, 2026

Excellent panelists discussing fasting duration and patient safety throughout the pre-, intra-, and post-operative periods. This is a very important topic! As a pediatrician, emergency physician, and pediatric surgeon, I congratulate you for organizing this event with professionals who have such extensive experience in the field!

The topics to be discussed are excellent, given their importance. As a pediatrician and pediatric surgeon, I congratulate the speakers on this initiative.

Liquid Fasting Before an Operation: Reducing Risk, Improving Care

Overview