Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery

Amer, Mohammad A.; Smith, Mark D.; Herbison, Peter; Plank, Lindsay D.; McCall, John

doi:10.1002/bjs.10408

Cited by 149 publications

(119 citation statements)

References 71 publications

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“…In a recent meta‐analysis, a pooled analysis of patients that underwent various elective surgical procedures demonstrated a significant reduction in length of hospital stay for both high dose and low dose carbohydrate loading when compared to patients that were fasting (−1.7 and −1.4 days, respectively). However, in a subgroup analysis of patients that underwent major abdominal surgery, a significantly shorter length of hospital stay was only found for high dose carbohydrate loading when compared to both fasting (−1.7 days) and placebo or water (−1.4 days) . Only a pooled analysis was performed for insulin resistance, which demonstrated a significantly decreased insulin resistance in patients that received a high dose carbohydrate load when compared to both fasting and placebo or water .…”

Section: Perioperative Periodmentioning

confidence: 99%

“…The proposed mechanism is that carbohydrate loading causes an initial increase in insulin sensitivity when compared to a fasting state, which is believed to dampen surgery‐induced insulin resistance . However, randomized controlled trials and meta‐analysis that investigated the effects of carbohydrate loading came to inconsistent conclusions . In a recent meta‐analysis, a pooled analysis of patients that underwent various elective surgical procedures demonstrated a significant reduction in length of hospital stay for both high dose and low dose carbohydrate loading when compared to patients that were fasting (−1.7 and −1.4 days, respectively).…”

Section: Perioperative Periodmentioning

confidence: 99%

“…9 However, randomized controlled trials and meta-analysis that investigated the effects of carbohydrate loading came to inconsistent conclusions. 8,54,55 In a recent metaanalysis, a pooled analysis of patients that underwent various elective surgical procedures demonstrated a significant reduction in length of hospital stay for both high dose and low dose carbohydrate loading when compared to patients that were fasting (−1.7 and −1.4 days, respectively). However, in a subgroup analysis of patients that underwent major abdominal surgery, a significantly shorter length of hospital stay was only found for high dose carbohydrate loading when compared to both fasting (−1.7 days) and placebo or water (−1.4 days).…”

Section: Carbohydrate Loadingmentioning

confidence: 99%

“…However, in a subgroup analysis of patients that underwent major abdominal surgery, a significantly shorter length of hospital stay was only found for high dose carbohydrate loading when compared to both fasting (−1.7 days) and placebo or water (−1.4 days). 54 Only a pooled analysis was performed for insulin resistance, which demonstrated a significantly decreased insulin resistance in patients that received a high dose carbohydrate load when compared to both fasting and placebo or water. 54 No differences were observed regarding complication rates.…”

Section: Carbohydrate Loadingmentioning

confidence: 99%

See 3 more Smart Citations

Nutritional aspects of enhanced recovery after esophagectomy with gastric conduit reconstruction

Kingma

Steenhagen

Ruurda

et al. 2017

Journal of Surgical Oncology

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Enhanced Recovery After Surgery (ERAS) aims to accelerate recovery by a set of multimodality management strategies. For esophagectomy, several nutritional elements of ERAS can be safely introduced and are advised in routine practice, including preadmission counseling to screen and treat for potential malnutrition, shortened preoperative fasting, and carbohydrate loading. However, the timing of oral intake and the use of routine nasogastric decompression remain matter of debate after esophagectomy. Furthermore, more research is needed on future developments such as perioperative immunonutrition.

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Section: Perioperative Periodmentioning

confidence: 99%

Section: Perioperative Periodmentioning

confidence: 99%

Section: Carbohydrate Loadingmentioning

confidence: 99%

Section: Carbohydrate Loadingmentioning

confidence: 99%

See 2 more Smart Citations

Nutritional aspects of enhanced recovery after esophagectomy with gastric conduit reconstruction

Kingma

Steenhagen

Ruurda

et al. 2017

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…In this context, ingestion of an oral carbohydrate solution a few hours before esophagectomy is advised, as it is believed to cause an initial increase in baseline insulin sensitivity and in that way dampens surgery‐induced insulin resistance . Although randomized controlled trials were inconsistent, a recent meta‐analysis of studies including a variety of surgical procedures indicated that carbohydrate loading may be associated with a reduced length of hospital stay compared with placebo or fasting . While the reported carbohydrate doses are varying, an amount of 400 mL of 12.5% carbohydrate solution may be advised .…”

Section: Enhanced Recovery After Esophagectomy In the Preoperative Sementioning

confidence: 99%

Surgical treatment of esophageal cancer in the era of multimodality management

Borggreve

Kingma

Домрачев

et al. 2018

Annals of the New York Academy of Sciences

115

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Over the last decades, the treatment of resectable esophageal cancer has evolved into a multidisciplinary process in which all players are essential for treatment to be successful. Medical oncologists and radiation oncologists have been increasingly involved since the implementation of neoadjuvant therapy, which has been shown to improve survival. Although esophagectomy is still considered the cornerstone of curative treatment for locally advanced esophageal cancer, it remains associated with considerable postoperative morbidity, despite promising results of minimally invasive techniques. In this light, both physical status and response to neoadjuvant therapy may be important factors for selecting patients who will benefit from surgery. Furthermore, it is important to optimize the entire perioperative trajectory: from the initial outpatient clinic visit to postoperative discharge. Enhanced recovery after surgery is increasingly recognized for esophagectomy and emphasizes perioperative aspects, such as nutrition, physiotherapy, and pain management. To date, several facets of esophageal cancer treatment remain topics of debate, such as the preferred neoadjuvant treatment, anastomotic technique, extent of lymphadenectomy, organization of postoperative care, and the role of surgery beyond locally advanced disease. Here, we describe the current and future perspectives in the surgical treatment of patients with esophageal cancer in the context of the available literature.

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Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

et al. 2021

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ERAS) is a global surgical quality improvement initiative now firmly entrenched within the field of perioperative care. Although ERAS is associated with significant clinical outcome improvements and cost savings in numerous surgical specialties, several opportunities and challenges deserve further discussion.OBSERVATIONS Uptake and implementation of ERAS Society guidelines, together with ERAS-related research, have increased exponentially since the inception of the ERAS movement. Opportunities to further improve patient outcomes include addressing frailty, optimizing nutrition, prehabilitation, correcting preoperative anemia, and improving uptake of ERAS worldwide, including in low-and middle-income countries. Challenges facing enhanced recovery today include implementation, carbohydrate loading, reversal of neuromuscular blockade, and bowel preparation. The COVID-19 pandemic poses both a challenge and an opportunity for ERAS. CONCLUSIONS AND RELEVANCETo date, ERAS has achieved significant benefit for patients and health systems; however, improvements are still needed, particularly in the areas of patient optimization and systematic implementation. During this time of global crisis, the ERAS method of delivering care is required to take surgery and anesthesia to the next level and bring improvements in outcomes to both patients and health systems.

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Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery

Abstract: Carbohydrate loading before elective surgery conferred a small reduction in length of postoperative hospital stay compared with fasting, and no benefit in comparison with water or placebo.

Cited by 149 publications

References 71 publications

Nutritional aspects of enhanced recovery after esophagectomy with gastric conduit reconstruction

Nutritional aspects of enhanced recovery after esophagectomy with gastric conduit reconstruction

Surgical treatment of esophageal cancer in the era of multimodality management

Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

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