Effects of Preoperative Oral Electrolyte‐Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Abstract

Objective Patients undergoing total knee arthroplasty (TKA) were primarily geriatric, with high risk of postoperative electrolyte disorders and malnutrition. Randomized controlled trials regarding oral nutrition supplement (ONS) strategies in TKA was sparse. This study aimed to evaluate the efficacy of preoperative oral electrolyte‐carbohydrate nutrition supplement (OECNS) on patients (aged >65 years) undergoing TKA. Methods From April 2019 to January 2020, 94 patients undergoing primary elective unilateral TKA in our hospital were considered in this prospective randomized controlled study. This study included patients aged over 65 years with ASA I‐III, and excluded patients with electrolyte disorders, malnutrition, and comorbidities. The control group (control group) received meal nutrition supplements (preoperative 6 h [Pre 6h]) and water (Pre 2h), while OECNS group (intervention group) received meal nutrition supplements (Pre 6h) and OECNS (Pre 2). The Student's t test and χ2 test was used. The primary outcomes were the patient‐reported comfort indicators (PRCIs) including hunger, thirst, nausea, vomiting, weakness, pain, anxiety, and general comfort. The secondary outcomes included indicators of electrolyte, nutrition, functional scores, clinical results, and complications. Results The scores of preoperative hunger (0.43 ± 0.10), pain (2.30 ± 0.34), and anxiety (9.04 ± 2.71) were significantly lower in OECNS group compared with control group (hunger, 1.19 ± 0.21; pain, 3.79 ± 0.26; anxiety, 11.21 ± 3.02) (Pre 1h) (all p < 0.05) as well as the weakness score on the first postoperative day (POD1) (OECNS group 3.57 ± 0.24; control group 5.15 ± 0.29; p < 0.001). A higher level of Na + (OECNS group 140.54 ± 3.39; control group 138.07 ± 5.21; p = 0.008) and a reduced rate of hyponatremia (OECNS group 6.4%; control group 21.3%; p = 0.036) on POD1 were found. Moreover, the higher level of blood glucose (Post 2h) and reduced rates of abnormal blood glucose (Pre 2h, Post 6h) were verified in control group (all p < 0.05). There was no significant difference regarding the other outcomes. Conclusion The administration of OECNS significantly improved subjective comfort, electrolytes, and blood glucose without increasing the rates of complications in patients (aged over 65 years) undergoing TKA.

Application of enhanced recovery after surgery in perioperative nursing care of elderly patients with hip and knee arthroplasty: A systematic review and meta-analysis

“…[1] As society ages, elderly orthopedic patients account for a considerable proportion of orthopedic patients, most of whom require surgical treatment, and the risk of electrolyte disorders and malnutrition after surgery is high. [2] Most organs in elderly people are already aging, and postoperative recovery is relatively slow, resulting in longer hospital stays. [1] In the perioperative care of elderly orthopedic patients, it is especially important to accelerate recovery, reduce pain of elderly patients, and reduce the incidence of postoperative complications.…”

Preprocedural fasting policies for patients receiving tube feeding: A national survey

“…However, it is likely that, similarly to nonenterally fed patients, such patients experience the adverse effects of prolonged fasting: hunger, thirst, anxiety, increased pain. 7,8 Current guidelines do not provide preprocedural fasting recommendations for patients who receive tube feeding [9][10][11][12][13][14] and suggest an increased risk of pulmonary aspiration in this population. 14 The lack of clinical evidence or societal guidelines on optimal preprocedural fasting and an indication of increased risk in patients who receive tube feeding may promote unnecessary and potentially harmful restrictive fasting practices.…”

“…Data on harm from preoperative fasting in patients who are not critically ill who receive enteral feeding are scarce. However, it is likely that, similarly to nonenterally fed patients, such patients experience the adverse effects of prolonged fasting: hunger, thirst, anxiety, increased pain 7,8 …”

Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection

“…Of more significant concern is the high prevalence of malnutrition in the TJA population, ranging from 8.5% to 50%, suggesting that we have a considerable opportunity to improve their clinical outcomes further [ 18 ]. Recent studies have further confirmed that nutritional interventions for TJA patients could provide postoperative benefits [ 19 , 20 , 21 ].…”