Effect of Pre-operative Carbohydrate Loading in Femur Fracture: A Randomized Controlled Trial

Abstract

BackgroundFemur fracture exhibits a major clinical burden among the elderly people, leading patients to be bedridden for a long time in the hospital. The body is more likely to be in a catabolic state as a result of the prolonged fasting period required for surgery, prominent to an increase in insulin resistance. Pre-operative carbohydrate loading has been shown to improve postoperative outcomes in several countries, however no studies on this topic have yet been reported in Nepal. The aim of the study was to evaluate the effect of pre-operative carbohydrate loading in femur fracture surgery.MethodsThis study was a hospital-based, open-label, two-armed, randomized controlled trial. A total of 66 participants were included in this study and assigned to control group (n = 33) and study group (n = 33). Participants aged 50 years and above were recruited randomly through computer-generated random number between August 2020 and November 2021. Those who underwent femur fracture surgery were enrolled in this study. The pre-operative nutritional status was identified and the post-operative outcomes were measured using the Visual Analogue Score (VAS), Cumulative Ambulatory Score (CAS), and Modified Barthel Index (MBI) score system. Statistical analysis were performed using the Chi-square test and independent t-test to compare between the outcomes between two groups.ResultsAll the participants completed the study. The effect of carbohydrate loading showed a significant reduction in the post-operative pain in the study group than that of the control group (4.1 ± 1.8 versus 6.1 ± 2.1, p = 0.010) and higher functional mobility (8.1 ± 2.6 versus 6.8 ± 2.8, p = 0.033). The hospital stay in the study group was also shorter than in the control group (6.7 ± 2.4 versus 8.8 ± 4.5, p = 0.024).ConclusionsThe uptake of carbohydrate loading showed reduced post-operative pain, enhanced functional mobility, and decreased length of hospital stay. This study warrants a revision of current guidelines, which shed more light on the necessity of the provision of pre-operative carbohydrate loading in a clinical setting.Trial registration: ClinicalTrials.gov identifier: NCT04838366. Registered 9 April, 2021, https://clinicaltrials.gov/ct2/show/NCT04838366