M. A. Amer1,3, M. D. Smith1,4, G. P. Herbison2, L. D. Plank5, J. L. McCall1,3,5,6 1University Of Otago,Department Of Surgical Sciences, Dunedin School Of Medicine,Dunedin, OTAGO, New Zealand 2University Of Otago,Department Of Preventive And Social Medicine, Dunedin School Of Medicine,Dunedin, OTAGO, New Zealand 3Dunedin Hospital,Department Of General Surgery,Dunedin, OTAGO, New Zealand 4Southland Hospital,Department Of General Surgery,Invercargill, SOUTHLAND, New Zealand 5University Of Auckland,Department Of Surgery, School Of Medicine,Auckland, AUCKLAND, New Zealand 6Auckland City Hospital,New Zealand Liver Transplant Unit,Auckland, AUCKLAND, New Zealand
Introduction:
The aim was to determine the effects of preoperative carbohydrate (CHO) administration on clinically relevant postoperative outcomes in adult patients undergoing elective surgery. Three recent meta-analyses have summarized the results of randomized clinical trials (RCTs) that examined this, however, these could not account for the different doses of CHO administered and the different controls used. Multiple-treatments meta-analysis (MTM) allows for robust synthesis of all available evidence in these situations.
Methods:
Article databases were systematically searched for RCTs comparing preoperative carbohydrate administration with water, a placebo drink, or fasting. A four treatment MTM was performed comparing two CHO dose groups (low: 10–44g; high: >45g) with two control groups (fasting; water or placebo). Primary outcomes were length of hospital stay and postoperative complication rate. Secondary outcomes included postoperative insulin resistance, vomiting and fatigue.
Results:
Results 43 trials, involving 3110 participants were included. Compared to fasting, preoperative low dose and high dose CHO administration decreased postoperative length of stay by 0.4 days (95% confidence interval (CI) 0.03 – 0.7) and 0.2 days (95% CI 0.04 – 0.4) respectively. There was no significant decrease in length of stay compared to water or placebo. There was no significant difference in the postoperative complication rate, or in most of the secondary outcomes, between the CHO and control groups.
Conclusion:
CHO loading before elective surgery conferred a small reduction in length of stay when compared to fasting, but no significant difference when compared to water or placebo. No other clinically significant effect on post-operative outcomes was found.