A preliminary, randomised controlled trial of preoperative oral carbohydrate drinks on postoperative walking capacity in elective colorectal surgery

Abstract

The measured outcomes were: length of stay (LOS), complication rate, readmission rate, compliance with ERAS protocol elements and recovery parameters (tolerance of early oral diet, mobilisation and time to first flatus). Results: Group 1 (colon) consisted of 150 patients and Group 2 (rectum) of 82 patients. There was no statistical difference between the two group based on other demographic parameters such as ASA scale, BMI and the stage of cancer. Patients in Group 1 were discharged home earlier than in Group 2-median LOS 4 vs. 5 days respectively (p¼0.046). There was no statistical difference in complication rate (27.3% vs. 36.6%, p¼0.14), severity of complications according to Clavien-Dindo classification (p¼0.58) and readmissions (7.3% vs. 6.1%, p¼0.72). Compliance with the protocol was 86.9% and 82.6% respectively (p¼0.07). However, in Group 1 the following procedures were used less frequently: bowel preparation (24% vs. 78.3%) and postoperative drainage (23.3% vs. 71.0%). There were no differences in recovery parameters between the groups: tolerance of an oral diet on the 1st postoperative day (76.7% vs. 68.3%, p¼0.17), mobilisation of a patient on the day of surgery (90.7% vs. 82.9%, p¼0.09), time to first flatus (1.8 ± 1.4 vs. 2.1 ± 1.9 days respectively, p¼0.64). Univariate logistic regression showed that the type of surgery (OR 1.89, 95% CI 1.10-3.27), drainage (OR 3.42, 95% CI 1.95-5.99), bowel preparation (OR 2.81, 95% CI 1.63-4.86) and stoma creation (OR 2.70, 95% CI 1.38-5.28) prolonged LOS significantly. In a multivariate logistic regression model only a bowel preparation (OR 2.24, 95% CI 1.19-4.20) and drainage (OR 2.85, 95% CI 1.54-5.28) were shown to be significant. Conclusion: Although functional recovery and high compliance with ERAS protocol is possible irrespective of the type of surgery, laparoscopic rectal resections were associated with a longer LOS Disclosure of interest: None declared.

The impact of orthostatic intolerance on early ambulation following abdominal surgery in an enhanced recovery programme

“…Accordingly, the distances covered the day after surgery by our patients almost twice as much as those reported in other colorectal studies without ERP. 22,23 Finally, our walk tests were standardised 16 and supervised by only two physiotherapists to reduce variability in test performance.…”

2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration—A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting

“…The body of evidence included 139 studies (adult surgical: 99 randomized controlled trials, [23][24][25][26][27][28][29][30][31][32][33][34][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86]91, 7 nonrandomized trials, 65,66,87,152,158-160 3 prospective cohort studies, 90,161,162 2 retrospective cohort studies, 163,164 1 case-control study, 165 and 2 before-after studies 67,166 ; adult nonsurgical: 1 Practice Guidelines for Preoperative Fasting PRACTICE PARAMETER randomized controlled trial, 167 9 crossover, [168][169][170][171][172][173][174][175][176] and 2 nonrandomized trials 177,178 ; pediatric surgical: 9 randomized controlled trials, 100,113,179-185 1 ...…”

“…No aspiration after carbohydrate-containing clear or noncaloric clear liquids was reported in 17 randomized controlled trials. 23,24,26,39,55,57,59,63,74,75,77,78,80–84 (strength of evidence not rated due to lack of events). Regurgitation 49,55,77 or preoperative vomiting 39,75,82,85 did not differ in randomized controlled trials (very low strength of evidence).…”

“…The body of evidence included 139 studies (adult surgical: 99 randomized controlled trials, 23–34,36–64,68–86,91,118–157 7 nonrandomized trials, 65,66,87,152,158–160 3 prospective cohort studies, 90,161,162 2 retrospective cohort studies, 163,164 1 case-control study, 165 and 2 before–after studies 67,166 ; adult nonsurgical: 1 randomized controlled trial, 167 9 crossover, 168–176 and 2 nonrandomized trials 177,178 ; pediatric surgical: 9 randomized controlled trials, 100,113,179–185 1 prospective cohort 186 ; and pediatric nonsurgical: 2 randomized controlled trial, 102,104 1 crossover, 35 and 1 prospective cohort 103 ) comparing carbohydrate-containing clear liquids (simple, complex) with water, placebo, or fasting. In the carbohydrate arms, liquids were allowed an average of 2.25 h before surgery (80% until 2 h).…”