Evaluation of preoperative carbohydrate loading compared to preoperative fasting for enhanced recovery after elective gynecological surgeries
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20243591Keywords:
Bowel activity, Postoperative recovery, Clinical outcomes, Elective gynecological surgery, Preoperative carbohydrate loading, Insulin resistanceAbstract
Background: This study aimed to evaluate the impact of preoperative carbohydrate loading on insulin resistance and clinical outcomes in patients undergoing elective gynecological surgeries.
Methods: A single-center, parallel-group, randomized controlled study was conducted at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. Thirty-nine patients were randomized into two groups: the carbohydrate loading group (CHO, n=20) received 600 ml of a carbohydrate-rich drink the day before surgery and 200 ml two hours before surgery; the control group (CO, n=19) fasted overnight.
Results: Baseline serum insulin, blood glucose, and insulin resistance levels were similar between the groups. Two hours before surgery, the CO group had significantly higher serum insulin levels (7.5±5.6 IU/ml) compared to the CHO group (4.5±2.9 IU/ml) (t=2.08, p=0.04). Insulin resistance was also higher in the CO group (1.9±1.6) compared to the CHO group (0.9±0.6) (t=2.40, p=0.02). Seventy-five percent of the CHO group regained bowel sounds within 24 hours post-surgery, compared to seventy-three percent of the CO group, who achieved bowel sounds after 24 hours (χ²=9.24, p=0.02). No significant differences were observed in postoperative mobilization, urinary catheter removal, fever, nausea, vomiting, length of hospital stay, or surgical site infections.
Conclusions: Preoperative carbohydrate loading reduces insulin resistance and facilitates faster bowel recovery without increasing postoperative complications in elective gynecological surgery.
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References
Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations — Part I. Gynecol Oncol. 2016;140:313-22.
Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G, Altman A, Meyer LA, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update. Int J Gynecol Cancer. 2019;29:651-68.
Kratzing C. Pre-operative nutrition and carbohydrate loading. Proc Nutr Soc. 2011;70:311-5.
Mathur S, Plank LD, McCall JL, Shapkov P, McIlroy K, Gillanders LK, et al. Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Br J Surg. 2010;97:485-94.
Matthews DR, Hosker JR, Rudenski AS, Naylor BA, Treacher DF, Turner RC, et al. Homeostasis model assessment: insulin resistance and fl-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-9.
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.
Gianotti L, Biffi R, Sandini M, Marrelli D, Vignali A, Caccialanza R, et al. Preoperative Oral Carbohydrate Load Versus Placebo in Major Elective Abdominal Surgery (PROCY): A Randomized, Placebo-controlled, Multicenter, Phase III Trial. Ann Surg. 2018;267:623-30.
Smith I, Kranke P, Murat I, Smith A, OʼSullivan G, Sreide E, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28:556-69.
Liu B, Wang Y, Liu S, Zhao T, Zhao B, Jiang X, et al. A randomized controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing elective craniotomy. Clin Nutr. 2019;38:2106-12.
Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre- operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis. 2006;8:563-9.
Nygren J, Thacker J, Carli F, Fearon KCH, Norderval S, Lobo DN, et al. Guidelines for Perioperative Care in Elective Rectal/Pelvic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg. 2013;37:285-305.
Hausel J, Nygren J, Thorell A, Lagerkranser M, Ljungqvist O. Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. Br J Surg. 2005;92:415-21.
Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations. Clin Nutr. 2013;32:879-87.
Harsten A, Hjartarson H, Toksvig-Larsen S. Total hip arthroplasty and perioperative oral carbohydrate treatment: a randomised, double-blind, controlled trial. Eur J Anaesthesiol. 2012;29:271-4.
Tran S, Wolever TMS, Errett LE, Ahn H, Mazer CD, Keith M. Preoperative Carbohydrate Loading in Patients Undergoing Coronary Artery Bypass or Spinal Surgery. Anesth Analg. 2013;117:305-13.
Laffin MR, Li S, Brisebois R, Senior PA, Wang H. The Use of a Pre-operative Carbohydrate Drink in Patients with Diabetes Mellitus: A Prospective, Non-inferiority, Cohort Study. World J Surg. 2018;42:1965-70.
Gustafsson UO, Nygren J, Thorell A, Soop M, Hellström PM, Ljungqvist O, et al. Pre- operative carbohydrate loading may be used in type 2 diabetes patients: Pre-operative carbohydrate load in diabetes patients. Acta Anaesthesiol Scand. 2008;52:946-51.
Zhang Y, Min J. Preoperative Carbohydrate Loading in Gynecological Patients Undergoing Combined Spinal and Epidural Anesthesia. J Invest Surg. 2020;33:587-95.
Faria MSM, de Aguilar-Nascimento JE, Pimenta OS, Alvarenga LC, Dock-Nascimento DB, Slhessarenko N. Preoperative Fasting of 2 Hours Minimizes Insulin Resistance and Organic Response to Trauma After Video-Cholecystectomy: A Randomized, Controlled, Clinical Trial. World J Surg. 2009;33:1158.
Onalan E, Andsoy II, Ersoy OF. The Effect of Preoperative Oral Carbohydrate Administration on Insulin Resistance and Comfort Level in Patients Undergoing Surgery. J Perianesth Nurs. 2019;34:539-50.
Bilku D, Dennison A, Hall T, Metcalfe M, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014;96:15-22.
Kaška M, Grosmanová T, Havel E, Hyšpler R, Petrová Z, Brtko M, et al. The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery – a randomized controlled trial. Wien Klin Wochenschr. 2010;122:23-30.
Alimena S, Falzone M, Feltmate CM, Prescott K, Contrino Slattery L, Elias K. Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol. Int J Gynecol Cancer. 2020;30:533-40.
Gianotti L, Biffi R, Sandini M, Marrelli D, Vignali A, Caccialanza R, et al. Preoperative Oral Carbohydrate Load Versus Placebo in Major Elective Abdominal Surgery (PROCY): A Randomized, Placebo-controlled, Multicenter, Phase III Trial. Ann Surg. 2018;267:623-30.
