Key result
Preoperative carbohydrate loading reduces perioperative insulin resistance and hyperglycemia without affecting surgery-related morbidity.
Why the study?
Recent studies on preoperative carbohydrate loading in surgical patients showed variability in dosing and timing, with many underpowered and focusing on surrogate endpoints.
Does preoperative carbohydrate loading improve perioperative outcomes in surgical patients?
Systematic Review
Does preoperative carbohydrate loading improve perioperative outcomes in surgical patients?
Preoperative carbohydrate loading up to 2 hours before surgery is safe and improves metabolic and patient-reported outcomes, though it does not reduce surgical morbidity.
Preoperative carbohydrate loading up to 2 h preoperatively appears safe with surrogate benefits; leaves open effects on morbidity pending powered RCTs.
PURPOSE OF REVIEW: The aim of this review is to give an overview of recently published articles covering preoperative carbohydrate loading in surgical patients. RECENT FINDINGS: Between January 1, 2017, and December 31, 2019, 26 publications addressing the effect of carbohydrate load were retrieved through a systematic search. Seventeen were randomized clinical trials, three prospective observational studies and six retrospective series with case-control comparison. Most of the studies were underpowered, addressed surrogate endpoints, and variability among dose and timing of carbohydrate (CHO) treatment was high. The most recent literature endorses preoperative carbohydrate loading up to 2 h before operations as a safe treatment. The new evidence confirm that this strategy is effective in reducing perioperative insulin resistance and the proportion of hyperglycemia episodes, and improving patient well-being and comfort but without affecting surgery-related morbidity. SUMMARY: Further properly designed randomized clinical trials, addressing more clinically relevant endpoints such as length of hospitalization and morbidity rate, are warrant.
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Gianotti et al. (2020) conducted a systematic review in Surgical patients. Preoperative carbohydrate loading was evaluated on Perioperative insulin resistance, hyperglycemia episodes, patient well-being, and surgery-related morbidity. Preoperative carbohydrate loading up to 2 hours before surgery reduces perioperative insulin resistance and hyperglycemia episodes, but does not affect surgery-related morbidity.
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