Key result
Preoperative oral carbohydrates did not significantly affect postoperative insulin resistance (HOMA-IR 2.4 vs 2.6; P=0.817) or preoperative gastric volume (30.8 vs 35.5 mL; P=0.696) in older adults.
Why the study?
Preoperative carbohydrate drinks reduce fasting time, but older adults may face risks of pulmonary aspiration and hyperglycemia due to increased insulin resistance and delayed gastric emptying.
Does preoperative oral carbohydrate consumption affect insulin resistance or gastric volume in older adults undergoing total hip or knee arthroplasty?
RCT (n=56)
randomly assigned
Does preoperative oral carbohydrate consumption affect insulin resistance or gastric volume in older adults undergoing total hip or knee arthroplasty?
Preoperative oral carbohydrate consumption does not worsen insulin resistance or increase gastric volume in older adults undergoing joint arthroplasty, supporting its safety in this population.
This is the authors' abstract. We don't add key points for this paper.
INTRODUCTION: Preoperative carbohydrate drinks are recommended to reduce fasting time before surgery. Older adults are at risk of pulmonary aspiration and hyperglycemia after consuming carbohydrate drinks because of increased insulin resistance and delayed gastric emptying. We investigated the effects of oral carbohydrate drinks on perioperative insulin resistance, metabolic responses, and gastric volume in older adults. METHODS: Fifty-six patients (aged more than 65 years) were randomly assigned to the control or carbohydrate (CHO) group. The CHO group received 400 mL of a carbohydrate drink 2 to 3 hours before anesthesia. The control group was allowed clear fluid intake 2 hours before anesthesia. Blood glucose and insulin levels were measured before intake of the carbohydrate drink and 1 hour postoperatively. Gastric volume was measured before spinal anesthesia. Insulin resistance was calculated using the homeostasis model assessment for insulin resistance. RESULTS: Homeostasis model assessment for insulin resistance was not different between the control and CHO groups preoperatively (2.5 versus 3.3, P = 0.156) or postoperatively (2.6 versus 2.4, P = 0.817). Preoperative gastric volume was comparable between the control and CHO groups (35.5 versus 30.8 mL, P = 0.696). DISCUSSION: Preoperative oral consumption of carbohydrates did not affect insulin resistance or gastric volume in older adults undergoing total knee or hip arthroplasty. Preoperative carbohydrate loading is safe in older adults undergoing total knee or hip arthroplasty. DATA AVAILABILITY: The data that support the findings of this study are available from the corresponding author on reasonable request. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (No. NCT04206189).
Supports preoperative carbohydrate safety in older arthroplasty patients; extends evidence to this population.
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Choi et al. (2022) conducted an RCT in Total hip or knee arthroplasty (n=56). Oral carbohydrate drink vs. Clear fluid intake 2 hours before anesthesia was evaluated on Postoperative insulin resistance (HOMA-IR) (p=0.817). Preoperative oral carbohydrates did not significantly affect postoperative insulin resistance (HOMA-IR 2.4 vs 2.6; P=0.817) or preoperative gastric volume (30.8 vs 35.5 mL; P=0.696) in older adults.
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