Introduction: This preoperative fasting audit is a detailed examination of the actual practice of patient oral intake prior to surgical procedures at our tertiary care center. It aimed to assess the fasting guidelines provided to patients, ensuring their safety and well-being during the surgical process. Methods: This audit was conducted for a period of one month in October 2023 and it included 109 patients who underwent elective surgery of all ages and either gender. During this audit, we have meticulously analyzed the duration of fasting that the patients underwent before each type of surgery. This included a detailed record of the time intervals between the last meal or drink and the scheduled operation, with regards to the nature of food or drink that patients were allowed or denied from consuming prior to the procedure. Results: Majority of the patients in this study underwent orthopedic procedures (57/109, 52.3%). The average duration of fasting was 9.66 h. Only 26.4% of patients were fasting for the recommended 8-hr period. 45.8% were noted to be fasting between 9-10 hr. Overall, a total of 72.4% of patients exceeded the recommended 6-8 hr preoperative fasting. 18 (16.5%) patients fasted between 12-16 h. An interesting finding of this audit was that only pediatric patients were drinking clear fluids up to allowable 2-hr preoperatively. Conclusion: Despite evolving guidelines advocating for shorter fasting periods, our study alongside similar studies revealed persistent challenges in translating these guidelines into routine practice.