Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol

Abstract

IntroductionPreoperative carbohydrate loading is an effective method to control postoperative insulin resistance. However, data are limited concerning the effects of carbohydrate loading on preoperative hyperglycemia and possible impacts on complication rates.MethodsA prospective cohort study was performed of patients enrolled in an enhanced recovery after surgery pathway at a single institution. All patients underwent laparotomy for known or suspected gynecologic malignancies. Patients who had been diagnosed with diabetes preoperatively and those prescribed total parenteral nutrition by their providers were excluded. Data regarding preoperative carbohydrate loading with a commercial maltodextrin beverage, preoperative glucose testing, postoperative day 1 glucose, insulin administration, and complications (all complications, infectious complications, and hyperglycemia-related complications) were collected. The primary endpoint of the study was the incidence of postoperative infectious complications, defined as superficial or deep wound infection, organ/space infection, urinary tract infection, pneumonia, sepsis, or septic shock.ResultsOf 415 patients, 76.9% had a preoperative glucose recorded. The mean age was 60.5±12.4 years (range 18–93). Of those with recorded glucose values, 30 patients (9.4%) had glucose ≥180 mg/dL, none of whom were actually given insulin preoperatively. Median preoperative glucose value was significantly increased after carbohydrate loading (122.0 mg/dL with carbohydrate loading vs 101.0 mg/dL without, U=3143, p=0.001); however, there was no relationship between carbohydrate loading and complications. There was a significantly increased risk of hyperglycemia-related complications with postoperative day 1 morning glucose values ≥140 mg/dL (OR 1.85, 95% CI 1.07 to 3.23; p=0.03). Otherwise, preoperative and postoperative hyperglycemia with glucose thresholds of ≥140 mg/dL or ≥180 mg/dL were not associated with increased risk of other types of complications.DiscussionCarbohydrate loading is associated with increased preoperative glucose values; however, this is not likely to be clinically significant as it does not have an impact on complication rates. Preoperative hyperglycemia is not a risk factor for postoperative complications in a carbohydrate-loaded population when known diabetic patients are excluded.PrecisWhile glucose increased with carbohydrate loading in non-diabetic patients, this was not associated with complications.

Impact of prehabilitation during neoadjuvant chemotherapy and interval cytoreductive surgery on ovarian cancer patients: a pilot study

“…Overall, preoperative carbohydrate loading has been shown to be an effective method to control postoperative insulin resistance [ 30 , 31 ]. However, data are limited concerning the effects of carbohydrate loading on preoperative hyperglycemia and insulin management in patients with ovarian cancer patients previous to interval cytoreductive surgery.…”

“…Preoperative carbohydrate loading in our prehabilitation group was not associated with intraoperative increased risk of hyperglycemia, postoperative insulin requirement neither intraoperative nor postoperative complications. Similarly, Alimena et al reported that carbohydrate loading was associated with an increase in preoperative glucose values without impacting the complication rates [ 31 ].…”

Without Urinary Catheter During Perioperative Period of Microvascular Decompression of Trigeminal Neuralgia: The Inspiration Under the Concept of Rapid Recovery

“…Fast-track surgery (FTS), also known as Enhanced Recovery After Surgery (ERAS), refers to the combination of optimization measures for perioperative treatment with evidence-based medical evidence, and the adoption of an optimized clinical path through multidisciplinary teamwork, in order to reduce the physical and psychological trauma stress of surgical patients, reduce complications and shorten hospital stays, and accelerate the recovery of patients [11]; FTS was first advocated by Danish physician Kehlet [12,13], and has been widely used in countries around the world [14][15][16][17][18].…”

Variación de niveles de glicemia perioperatoria en pacientes no diabéticas sometidas a cirugía gineco obstétrica

“…El tipo de cirugía en los valores de glicemia intraoperatoria con un incremento significativo (p< 0.05) en la cirugía abierta versus laparoscópica (87 mg/dl ± 7 vs 85 mg/dl ± 7) y no influye en los niveles de glicemia pre y posoperatoria (p> 0.05), así lo demuestran Khalimonchyk y Klygunenko en Ucrania durante el 2019 en su estudio determinan que los pacientes sometidos a técnica laparoscópica no muestran un incremento significativo de los niveles de glicemia intraoperatoria en relación con los valores preoperatorios, por su parte, Alimena y cols., muestran que las pacientes sometidas a cirugía abierta (laparotomía) incrementan sus niveles de glicemia intraoperatoria en comparación con los basales (27,28).…”