SP 1.15 Clinical and Metabolic Effects of Preoperative Carbohydrate Loading Before Colorectal Surgery: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Henrique Pivetta, Leticia Gatti Fonseca, Rodrigo Massoud, Marcílio Filho, Carlos Carvalho, Gunther PimentaAbstract
Aim
To evaluate the effects of abbreviated preoperative fasting using carbohydrate-containing beverages compared with traditional fasting or placebo in patients undergoing colorectal surgery.
Methods
PubMed, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials comparing patients receiving preoperative carbohydrate-containing beverages with those undergoing conventional fasting or placebo. Primary outcomes were plasma insulin and blood glucose levels at operating room admission and 24 hours postoperatively. Secondary outcomes included length of hospital stay, time to first defecation, postoperative ileus, and patient-reported postoperative symptoms such as nausea, vomiting, anxiety, hunger, and thirst.
Results
Twenty trials including 1,387 patients met the inclusion criteria; 49% received a preoperative oral carbohydrate-containing beverage. No significant differences were observed in plasma insulin levels at operating room admission (MD −0.19; 95% CI −1.44 to 1.07; p=0.59) or at 24 hours postoperatively (MD −3.63; 95% CI −10.49 to 3.23; p=0.19). Blood glucose levels were also similar at operating room admission (MD 2.71; 95% CI −10.96 to 16.39; p=0.61) and at 24 hours postoperatively (MD −8.58; 95% CI −35.57 to 18.40; p=0.41). Length of hospital stay (MD −1.71; 95% CI −2.64 to −0.78; p=0.0015) and time to first defecation (MD −0.95; 95% CI −1.72 to −0.19; p=0.02) were reduced in the carbohydrate group.
Conclusion
Preoperative carbohydrate-containing beverages improve postoperative recovery parameters without increasing adverse outcomes in patients undergoing colorectal surgery.