Effects of preoperative oral single-dose and double-dose carbohydrates on insulin resistance in patients undergoing gastrectomy:a prospective randomized controlled trial

Chen, Xinrong; Li, Ka; Yang, Kun; Hu, Jian-Kun; Yang, Jie; Feng, Jinhua; Hu, Yanjie; Zhang, Xingxia

doi:10.1016/j.clnu.2021.03.002

Cited by 15 publications

(13 citation statements)

References 36 publications

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“…The dehydrated states usually result in electrolyte disorders, such as hyponatremia, hypotension, etc. Our trial found a higher sodium level and reduced hyponatremia in the intervention group, and the results were similar to the previous studies 4 , 5 . The potassium and calcium levels were similar in the two groups, and the rates of hypokalemia and hypocalcemia did not differ between the two groups.…”

Section: Discussionsupporting

confidence: 92%

“…However, elderly patients who received TKA were exposed to high risks of postoperative electrolyte disorders and malnutrition. Studies found that malnutrition caused discomfort and anxiety, prolonged length of hospital stay, and affected clinical recovery 4 , 5 . In addition, electrolyte disorders had increased risks of delirium, myocardial infarction, and surgical site infection after orthopaedic surgeries 4 , 6 .…”

Section: Introductionmentioning

confidence: 99%

“…The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend patients to take standard ONS (i.e. carbohydrates, protein, vitamins, and other immune nutrients) during the preoperative period unrelated to their nutritional status 5 , 7 . Three randomized controlled trials (RCTs) reported the efficacy of ONS on general surgical patients, but their results were controversial 8 , 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

“…However, patients had to take four bags of nutrition power, which increased the digestive system burden of the elderly patients and increased the costs during the hospital stay. Recently, a clinical trial had found that 1000 mL of carbohydrate ONS administered the night before surgery did not improve any clinical outcomes but affected the patients' sleep quality, which resulted in shorter sleep time and more nighttime urination 5 . Therefore, we designed a novel and convenient ONS strategy that included a meal ONS given 6 h before surgery and an electrolyte‐carbohydrate nutrition supplement (OECNS) given 2 h before surgery with the cooperation of the departments of anesthesiology and nutrition.…”

Section: Introductionmentioning

confidence: 99%

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

Tang

Ning

et al. 2022

Orthopaedic Surgery

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Tang

Ning

et al. 2022

Orthopaedic Surgery

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“…There is currently sufficient evidence to support the hypothesis that the implementation of ERAS can indeed effectively improve the efficiency of the use of health service resources 14 and improve patient satisfaction with the diagnosis and treatment results. 15 16 However, there are variations in the implementation of ERAS for different regions, hospitals at different levels and experts in different disciplines, [17][18][19] which limits the application and popularisation of ERAS.…”

Section: Open Accessmentioning

confidence: 99%

Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

et al. 2022

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ObjectiveTo explore the attitudes and barriers encountered in the implementation of enhanced recovery after surgery (ERAS) in China from the perspective of multidisciplinary team members.DesignBased on Donabedian’s structure–process–outcome (SPO) model, a multicentre qualitative study using semistructured interviews was conducted.SettingFrom September 2020 to December 2020, the participants of this study were interviewed from six tertiary hospitals in Sichuan province (n=3), Jiangsu province (n=2) and Guangxi province (n=1) in China.ParticipantsA total of 42 members, including surgeons (n=11), anaesthesiologists (n=10), surgical nurses (n=14) and dietitians(n=7) were interviewed.ResultsMultidisciplinary team (MDT) members still face many barriers during the process of implementing ERAS. Eight main themes are described around the barriers in the implementation of ERAS. Themes in the structure dimension are: (1) shortage of medical resources, (2) lack of policy support and (3) outdated concepts. Themes in the process dimension are: (1) poor doctor–patient collaboration, (2) poor communication and collaboration among MDT members and (3) lack of individualised management. Themes in the outcome dimension are: (1) low compliance and (2) high medical costs. The current implementation of ERAS is still based on ideas more than reality.ConclusionsIn general, barriers to ERAS implementation are broad. Identifying key elements of problems in the application and promotion of ERAS from the perspective of the MDT would provide a starting point for future quality improvement of ERAS, enhance the clinical effect of ERAS and increase formalised ERAS utilisation in China.

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Trends in preoperative carbohydrate load practice: A systematic review

Canelli,

Louca,

Gonzalez

et al. 2024

J Parenter Enteral Nutr

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BackgroundThe preoperative carbohydrate load (PCL) is intended to improve surgical outcomes by reducing the catabolic state induced by overnight fasting. However, there is disagreement on the optimal PCL prescription, leaving local institutions without a standardized PCL recommendation. Results from studies that do not prescribe PCL in identical ways cannot be pooled to draw larger conclusions on outcomes affected by the PCL. The aim of this systematic review is to catalog prescribed PCL characteristics, including timing of ingestion, percentage of carbohydrate contribution, and volume, to ultimately standardize PCL practice.MethodsA comprehensive search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Randomized controlled trials were included if they studied at least one group of patients who were prescribed a PCL and the PCL was described with respect to timing of ingestion, carbohydrate contribution, and total volume.ResultsA total of 67 studies with 6551 patients were included in this systematic review. Of the studies, 49.3% were prescribed PCL on the night before surgery and morning of surgery, whereas 47.8% were prescribed PCL on the morning of surgery alone. The mean prescribed carbohydrate concentration was 13.5% (±3.4). The total volume prescribed was 648.2 ml (±377).ConclusionVariation in PCL practices prevent meaningful data pooling and outcome analysis, highlighting the need for standardized PCL prescription. Efforts dedicated to the establishment of a gold standard PCL prescription are necessary so that studies can be pooled and analyzed with respect to meaningful clinical end points that impact surgical outcomes and patient satisfaction.

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Effects of preoperative oral single-dose and double-dose carbohydrates on insulin resistance in patients undergoing gastrectomy:a prospective randomized controlled trial

Cited by 15 publications

References 36 publications

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

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

Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

Trends in preoperative carbohydrate load practice: A systematic review

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