A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery

Abstract

Purpose This study aimed to evaluate the effect of preoperative carbohydrate oral (CHO) loading on the postoperative metabolic and inflammatory response, perioperative discomfort and surgical clinical outcomes in open colorectal surgery compared with a conventional fasting protocol. Methods Fifty patients were randomly allocated to either the intervention group (CHO), to receive preoperative oral carbohydrate supplementation, or the control group (FAST), to undergo preoperative fasting. Insulin resistance, insulin sensitivity, the Glasgow Prognostic Score (GPS) and IL-6 levels were analysed at 06 h on the day of surgery (T 1 ), 6 h after surgery (T 2 ) and at 06 h on postoperative day 1 (T 3 ) and postoperative day 2 (T 4 ). Thirst, hunger, dry mouth, weakness, anxiety and pain were assessed using the visual analogue scale (VAS) prior to anaesthesia induction and at 0-4, 4-8, 8-12 and 12-24 h after surgery. Surgical clinical outcomes included the return of gastrointestinal function, time to independent ambulation and postoperative discharge day. Results Postoperative insulin resistance was 30% lower (p < 0.03) and insulin sensitivity was 15% higher (p < 0.05) in the CHO group than in the FAST group. The GPS was lower in the CHO group at T 1 (p < 0.001), T 3 (p < 0.01) and T 4 (p < 0.004). IL-6 serum levels were lower at the analysed postoperative time points in the CHO group (p < 0.001). The VAS well-being score was lower in the intervention group (p < 0.001); however, the VAS pain score was not significantly different between the groups. The evaluated surgical outcomes appeared earlier in the CHO group (p < 0.001). Conclusion A preoperative CHO drink reduced the postoperative metabolic and inflammatory response and improved subjective well-being and surgical clinical outcomes but did not diminish the VAS pain score.

Preoperative Carbohydrate Load and Intraoperative Goal-Directed Fluid Therapy for Elderly Patients Undergoing Open Gastrointestinal Operation: A Prospective Randomized Controlled Trial

“…As shown in some prior trials [16,25,28], our study also found that the GDFT protocol is associated with reductions in the rate of postoperative complications. In addition, the lower incidence of postoperative infection complications in the GDFT group may also be related to preoperative oral carbohydrate loading, which may reduce the metabolic and in ammatory response after surgery and improved surgical clinical outcomes [29]. However, the rates of postoperative complications in some previous studies were higher than in our present analysis.…”

Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial

“…In addition, we only monitored the incidence of postoperative complications that occurred during hospitalization, whereas Benes et al monitored patients for 30 days [25]. Lastly, the lower incidence of postoperative complications in our study may also be related to preoperative oral carbohydrate loading, which may reduce the metabolic and inflammatory response after surgery and improved surgical clinical outcomes [27]. Together, our results suggest that perioperative fluid optimisation reduces the incidence of postoperative complications in elderly patients, rather than only in high-risk patients.…”

Dietitian-led supportive care for postoperative nutritional achievement: A secondary analysis of a Randomized Controlled Trial

“…EDIA initiated earlier postoperative oral feeding as per ERAS recommendation. Majority of EDIA received intensive nutritional intervention where they were not only received the energy-dense clear uid ONS preoperative 3-hours but also energy-dense clear uid ONS postoperative once started clear uid and followed by energy-dense complete ONS after allowing solid diet while most of DDIA received plain water after allowed for clear uid, nourishing uid and followed by soft diet [29]. Postoperative intensive nutritional intervention management aimed to prevent nutritional depletion due to negative energy protein balance, maintain an appropriate nutritional status to support rehabilitation and wound healing [31].…”

“…These approaches minimize the energy protein negative balance, provide early energy protein supply, reduce protein loss, improve muscle function, and promote the anabolic state. Preservation of postoperative weight loss and muscle wasting could be achieved by minimizing body glycogen breakdown, glucose synthesis from protein or fat, and fat oxidation [29]. The body composition and handgrip strength conservations might result from the combined effect of shortening of preoperative fasting and postoperative early feeding.…”

“…Postoperative early oral feeding, where initiated clear uid ingestion 4-6 hours post-operation as one of the elements of ERAS recommendation [16], stimulates the early dietary intake and toleration in virtue of accelerating intestinal function recovery and prevents the occurrence of peristalsis of the stomach and small intestine and irregular contraction waves resulted from prolonged fasting. Thus, the intestinal mucosal barrier function could be maintained, and further accelerating organ recovery [29]. Preoperative CHO loading was shown a positive impact in minimizing insulin resistance and catabolism of muscle mass and subsequently resulted in the minimisation of postoperative complications and preservation of nutritional status and muscle strength [28].…”