Preoperative carbohydrate loading before colorectal surgery: a systematic review and meta-analysis of randomized controlled trials

Lu, Justin; Khamar, Jigish; McKechnie, Tyler; Lee, Yung; Amin, Nalin; Hong, Dennis; Eskicioglu, Cagla

doi:10.1007/s00384-022-04288-3

Cited by 7 publications

(3 citation statements)

References 44 publications

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“…After minimally invasive surgery, patients with complications exhibit a 1.4-fold increase in CRP levels at 24 h postoperatively and a 1.6-fold increase at 72 h postoperatively compared to those without complications [16] . Preoperative carbohydrate loading is a crucial strategy to mitigate surgical stress [17] , and the literature on its initiation timing and volume is well-established [18][19][20] . However, studies on early postoperative clear liquids are comparatively sparse.…”

Section: Highlightsmentioning

confidence: 99%

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Effects of preoperative and postoperative carbohydrate loading on gastrointestinal function and stress-induced inflammation after radical prostatectomy

Wang,

Xiao,

Wang

et al. 2024

International Journal of Surgery: Global Health

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Background: Early postoperative oral clear liquid diet has been shown to enhance postoperative recovery. However, the standard strategy for this diet has not been established. The authors’ aim was to investigate the combined effect of preoperative and early postoperative carbohydrate loading on postoperative stress and gastrointestinal function of patients by standardizing the starting time, type, volume, and concentration of carbohydrate drinks. Materials and methods: Fifty-three patients undergoing radical prostatectomy were randomly assigned to two groups. Both groups received a carbohydrate loading of 400 ml (12.5%) overnight and 2 h before surgery. The intervention group (n=29) started a 400 ml (12.5%) carbohydrate loading 6 h after surgery and consumed it within 24 h, while the control group (n=32) drank water. The primary outcomes–postoperative fasting blood glucose, fasting insulin, C-reactive protein (CRP), interleukin-6 levels, and gastrointestinal function–were recorded. Secondary outcomes included subjective comfort assessment, the first postoperative intake of semi-fluid food time, and drainage volume. Results: Compared with the control group, the intervention group had lower CRP levels on postoperative day 1 (POD1)/POD2 and less drainage volume on POD1. The intervention group also experienced shorter times to the first postoperative flatus and the first consumption of semi-fluid foods; their 72-h postoperative protein intake was higher than that of the control group. Conclusion: The results suggest that combined preoperative and postoperative carbohydrate loading can alleviate stress-induced inflammation and promote the recovery of postoperative gastrointestinal function.

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Section: Highlightsmentioning

confidence: 99%

“…Preoperative carbohydrate loading is a crucial strategy to mitigate surgical stress 17 , and the literature on its initiation timing and volume is well-established 18–20 . However, studies on early postoperative clear liquids are comparatively sparse.…”

Section: Introductionmentioning

confidence: 99%

Effects of preoperative and postoperative carbohydrate loading on gastrointestinal function and stress-induced inflammation after radical prostatectomy

Wang,

Xiao,

Wang

et al. 2024

International Journal of Surgery: Global Health

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“…Shortening preoperative fasting time and preoperative oral carbohydrate consumption are the core recommendations of ERAS for patients undergoing elective surgery [8]. Preoperative administration of oral carbohydrates is recognized for its ability to reduce metabolic stress and insulin resistance after surgery, leading to shorter hospital stays and improved wellbeing in patients undergoing abdominal, orthopedic, and cardiac surgery [9][10][11][12]. However, compared to the practice of fasting at midnight, preoperative oral carbohydrate intake does not appear to improve patient satisfaction or well-being in individuals undergoing thyroidectomy [13].…”

Section: Introductionmentioning

confidence: 99%

Effects of Preoperative Oral Carbohydrate on Perioperative Maternal Outcomes Undergoing Cesarean Section: A Systematic Review and Meta-Analysis

Shi,

Zheng,

Zhu

2024

Anesthesiology Research and Practice

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Purpose. Preoperative oral carbohydrate (CHO) is a rapid postoperative rehabilitation protocol that improves perioperative outcomes and is widely used in adult surgical patients. However, pregnant women are excluded because of the possibility of aspiration due to delayed gastric emptying. This meta-analysis was conducted to evaluate the efficacy of preoperative oral CHO in elective cesarean section. Methods. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to July 2023. Randomized controlled trials were included. The risk of bias was assessed using the Cochrane tool. Risk ratios and 95% confidence intervals were calculated. Meta-analysis was performed using random-effects models to estimate risk ratios and mean differences (MDs) with 95% confidence intervals (CIs). The outcomes included thirst and hunger scores, incidence of vomiting and nausea, time to flatus, and homeostatic model assessment of insulin resistance (HOMA-IR). Results. A total of nine studies with 1211 patients were included in the analysis. The levels of thirst and hunger were evaluated using a 10-point visual analog scale, with 0 representing the best and 10 representing the worst. The severity of hunger (weighted mean difference (WMD: −2.34, 95% CI: −3.13 to −1.54), time to flatus (WMD: −3.51 hours, 95% CI: −6.85 to −0.17), and HOMA-IR (WMD: −1.04, 95% CI: −1.31 to −0.77) were significantly lower in the CHO group compared to the control group. However, there were no significant differences in the severity of thirst or the incidence of vomiting and nausea between the CHO and control groups. Conclusion. Preoperative oral CHO during cesarean section alleviates thirst and hunger, shortens the time of postoperative flatus, and reduces HOMA-IR. However, the available evidence is insufficient to reach a clear consensus on the benefits or harms of preoperative oral CHO during cesarean section. Therefore, it is premature to make a definitive recommendation for or against its routine use.

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Perioperative systematic reviews and meta-analyses—time for design improvement

Kehlet

2023

Int J Colorectal Dis

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Preoperative carbohydrate loading before colorectal surgery: a systematic review and meta-analysis of randomized controlled trials

Cited by 7 publications

References 44 publications

Effects of preoperative and postoperative carbohydrate loading on gastrointestinal function and stress-induced inflammation after radical prostatectomy

Effects of preoperative and postoperative carbohydrate loading on gastrointestinal function and stress-induced inflammation after radical prostatectomy

Effects of Preoperative Oral Carbohydrate on Perioperative Maternal Outcomes Undergoing Cesarean Section: A Systematic Review and Meta-Analysis

Perioperative systematic reviews and meta-analyses—time for design improvement

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