Preoperative carbohydrate loading before colorectal surgery: a systematic review and meta-analysis of randomized controlled trials
Purpose Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative carbohydrate loading in colorectal surgery has never been synthesized. Methods MEDLINE, Embase, and CENTRAL were searched unt...
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Veröffentlicht in: | International journal of colorectal disease 2022-12, Vol.37 (12), p.2431-2450 |
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container_title | International journal of colorectal disease |
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creator | Lu, Justin Khamar, Jigish McKechnie, Tyler Lee, Yung Amin, Nalin Hong, Dennis Eskicioglu, Cagla |
description | Purpose
Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative carbohydrate loading in colorectal surgery has never been synthesized.
Methods
MEDLINE, Embase, and CENTRAL were searched until May 2021. Randomized controlled trials (RCTs) comparing patients undergoing colorectal surgery with and without preoperative carbohydrate loading were included. Primary outcomes were changes in blood insulin and glucose levels. A pairwise meta-analysis was performed using inverse variance random effects.
Results
The search yielded 3656 citations, from which 12 RCTs were included. In total, 387 patients given preoperative carbohydrate loading (47.2% female, age: 62.0 years) and 371 patients in control groups (49.4% female, age: 61.1 years) were included. There was no statistical difference for blood glucose and insulin levels between both patient groups. Patients receiving preoperative carbohydrate loading experienced a shorter time to first flatus (SMD: − 0.48 days, 95% CI: − 0.84 to − 0.12,
p
= 0.008) and stool (SMD: − 0.50 days, 95% CI: − 0.86 to − 0.14,
p
= 0.007). Additionally, length of stay was shorter in the preoperative carbohydrate loading group (SMD: − 0.51 days, 95% CI: − 0.88 to − 0.14,
p
= 0.007). There was no difference in postoperative morbidity and patient well-being between both groups.
Conclusions
Preoperative carbohydrate loading does not significantly impact postoperative glycemic control in patients undergoing colorectal surgery; however, it may be associated with a shorter length of stay and faster return of bowel function. It merits consideration for inclusion within colorectal enhanced recovery after surgery protocols. |
doi_str_mv | 10.1007/s00384-022-04288-3 |
format | Article |
fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2747275838</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A729673294</galeid><sourcerecordid>A729673294</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-35cc426e1b2da87b911b263c8610b8704c628c7b32d64f8f89b93b247287d81d3</originalsourceid><addsrcrecordid>eNp9kctu1TAQhiNERUvhBVggS2zYpPWttsOuqrhJlcoC1pZjTw6unPhgJ63Ckidn2lOgRQh5MeOZ7x95_DfNC0aPGKX6uFIqjGwp5y2V3JhWPGoOmBS8ZVzxx_fy_eZprZeUMq20fNLsCyU1V5odND8-FchbKG6OV0C8K33-uga8AknZhThtSA9DLtjLCYOfXSJ1KRso6xviSF3rDCOqPSlwFeGauCmQEWbXusmltcZK8kAKVvMYv0PAOdNcckqYziW6VJ81ewMGeH4XD5sv795-PvvQnl-8_3h2et56ofncihPvJVfAeh6c0X3HMFPCG8VobzSVXnHjdS94UHIwg-n6TvQcFzU6GBbEYfN6N3db8rcF6mzHWD2k5CbIS7VcI6tPjDCIvvoLvcxLwX1uqY5Kqtg9auMS2DgNeS7O3wy1p5p3SgveSaSO_kHhCTBG_AwYItYfCPhO4EuutcBgtyWOrqyWUXtjvN0Zb9F4e2u8FSh6effipR8h_Jb8choBsQMqtia0789K_xn7E7IHuNI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2749040618</pqid></control><display><type>article</type><title>Preoperative carbohydrate loading before colorectal surgery: a systematic review and meta-analysis of randomized controlled trials</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Lu, Justin ; Khamar, Jigish ; McKechnie, Tyler ; Lee, Yung ; Amin, Nalin ; Hong, Dennis ; Eskicioglu, Cagla</creator><creatorcontrib>Lu, Justin ; Khamar, Jigish ; McKechnie, Tyler ; Lee, Yung ; Amin, Nalin ; Hong, Dennis ; Eskicioglu, Cagla</creatorcontrib><description>Purpose
Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative carbohydrate loading in colorectal surgery has never been synthesized.
Methods
MEDLINE, Embase, and CENTRAL were searched until May 2021. Randomized controlled trials (RCTs) comparing patients undergoing colorectal surgery with and without preoperative carbohydrate loading were included. Primary outcomes were changes in blood insulin and glucose levels. A pairwise meta-analysis was performed using inverse variance random effects.
Results
The search yielded 3656 citations, from which 12 RCTs were included. In total, 387 patients given preoperative carbohydrate loading (47.2% female, age: 62.0 years) and 371 patients in control groups (49.4% female, age: 61.1 years) were included. There was no statistical difference for blood glucose and insulin levels between both patient groups. Patients receiving preoperative carbohydrate loading experienced a shorter time to first flatus (SMD: − 0.48 days, 95% CI: − 0.84 to − 0.12,
p
= 0.008) and stool (SMD: − 0.50 days, 95% CI: − 0.86 to − 0.14,
p
= 0.007). Additionally, length of stay was shorter in the preoperative carbohydrate loading group (SMD: − 0.51 days, 95% CI: − 0.88 to − 0.14,
p
= 0.007). There was no difference in postoperative morbidity and patient well-being between both groups.
Conclusions
Preoperative carbohydrate loading does not significantly impact postoperative glycemic control in patients undergoing colorectal surgery; however, it may be associated with a shorter length of stay and faster return of bowel function. It merits consideration for inclusion within colorectal enhanced recovery after surgery protocols.</description><identifier>ISSN: 1432-1262</identifier><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-022-04288-3</identifier><identifier>PMID: 36472671</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Analysis ; Blood glucose ; Blood sugar ; Carbohydrates ; Clinical trials ; Colorectal Surgery ; Diet, Carbohydrate Loading - methods ; Female ; Gastroenterology ; Hepatology ; Humans ; Insulin ; Internal Medicine ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Meta-analysis ; Middle Aged ; Morbidity ; Patients ; Postoperative Complications ; Preoperative Care - methods ; Proctology ; Randomized Controlled Trials as Topic ; Recovery (Medical) ; Review ; Surgery ; Well being</subject><ispartof>International journal of colorectal disease, 2022-12, Vol.37 (12), p.2431-2450</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>COPYRIGHT 2022 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-35cc426e1b2da87b911b263c8610b8704c628c7b32d64f8f89b93b247287d81d3</citedby><cites>FETCH-LOGICAL-c372t-35cc426e1b2da87b911b263c8610b8704c628c7b32d64f8f89b93b247287d81d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-022-04288-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-022-04288-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36472671$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lu, Justin</creatorcontrib><creatorcontrib>Khamar, Jigish</creatorcontrib><creatorcontrib>McKechnie, Tyler</creatorcontrib><creatorcontrib>Lee, Yung</creatorcontrib><creatorcontrib>Amin, Nalin</creatorcontrib><creatorcontrib>Hong, Dennis</creatorcontrib><creatorcontrib>Eskicioglu, Cagla</creatorcontrib><title>Preoperative carbohydrate loading before colorectal surgery: a systematic review and meta-analysis of randomized controlled trials</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Purpose
Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative carbohydrate loading in colorectal surgery has never been synthesized.
Methods
MEDLINE, Embase, and CENTRAL were searched until May 2021. Randomized controlled trials (RCTs) comparing patients undergoing colorectal surgery with and without preoperative carbohydrate loading were included. Primary outcomes were changes in blood insulin and glucose levels. A pairwise meta-analysis was performed using inverse variance random effects.
Results
The search yielded 3656 citations, from which 12 RCTs were included. In total, 387 patients given preoperative carbohydrate loading (47.2% female, age: 62.0 years) and 371 patients in control groups (49.4% female, age: 61.1 years) were included. There was no statistical difference for blood glucose and insulin levels between both patient groups. Patients receiving preoperative carbohydrate loading experienced a shorter time to first flatus (SMD: − 0.48 days, 95% CI: − 0.84 to − 0.12,
p
= 0.008) and stool (SMD: − 0.50 days, 95% CI: − 0.86 to − 0.14,
p
= 0.007). Additionally, length of stay was shorter in the preoperative carbohydrate loading group (SMD: − 0.51 days, 95% CI: − 0.88 to − 0.14,
p
= 0.007). There was no difference in postoperative morbidity and patient well-being between both groups.
Conclusions
Preoperative carbohydrate loading does not significantly impact postoperative glycemic control in patients undergoing colorectal surgery; however, it may be associated with a shorter length of stay and faster return of bowel function. It merits consideration for inclusion within colorectal enhanced recovery after surgery protocols.</description><subject>Analysis</subject><subject>Blood glucose</subject><subject>Blood sugar</subject><subject>Carbohydrates</subject><subject>Clinical trials</subject><subject>Colorectal Surgery</subject><subject>Diet, Carbohydrate Loading - methods</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Insulin</subject><subject>Internal Medicine</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Patients</subject><subject>Postoperative Complications</subject><subject>Preoperative Care - methods</subject><subject>Proctology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Recovery (Medical)</subject><subject>Review</subject><subject>Surgery</subject><subject>Well being</subject><issn>1432-1262</issn><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctu1TAQhiNERUvhBVggS2zYpPWttsOuqrhJlcoC1pZjTw6unPhgJ63Ckidn2lOgRQh5MeOZ7x95_DfNC0aPGKX6uFIqjGwp5y2V3JhWPGoOmBS8ZVzxx_fy_eZprZeUMq20fNLsCyU1V5odND8-FchbKG6OV0C8K33-uga8AknZhThtSA9DLtjLCYOfXSJ1KRso6xviSF3rDCOqPSlwFeGauCmQEWbXusmltcZK8kAKVvMYv0PAOdNcckqYziW6VJ81ewMGeH4XD5sv795-PvvQnl-8_3h2et56ofncihPvJVfAeh6c0X3HMFPCG8VobzSVXnHjdS94UHIwg-n6TvQcFzU6GBbEYfN6N3db8rcF6mzHWD2k5CbIS7VcI6tPjDCIvvoLvcxLwX1uqY5Kqtg9auMS2DgNeS7O3wy1p5p3SgveSaSO_kHhCTBG_AwYItYfCPhO4EuutcBgtyWOrqyWUXtjvN0Zb9F4e2u8FSh6effipR8h_Jb8choBsQMqtia0789K_xn7E7IHuNI</recordid><startdate>202212</startdate><enddate>202212</enddate><creator>Lu, Justin</creator><creator>Khamar, Jigish</creator><creator>McKechnie, Tyler</creator><creator>Lee, Yung</creator><creator>Amin, Nalin</creator><creator>Hong, Dennis</creator><creator>Eskicioglu, Cagla</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>202212</creationdate><title>Preoperative carbohydrate loading before colorectal surgery: a systematic review and meta-analysis of randomized controlled trials</title><author>Lu, Justin ; Khamar, Jigish ; McKechnie, Tyler ; Lee, Yung ; Amin, Nalin ; Hong, Dennis ; Eskicioglu, Cagla</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-35cc426e1b2da87b911b263c8610b8704c628c7b32d64f8f89b93b247287d81d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Analysis</topic><topic>Blood glucose</topic><topic>Blood sugar</topic><topic>Carbohydrates</topic><topic>Clinical trials</topic><topic>Colorectal Surgery</topic><topic>Diet, Carbohydrate Loading - methods</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Insulin</topic><topic>Internal Medicine</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Patients</topic><topic>Postoperative Complications</topic><topic>Preoperative Care - methods</topic><topic>Proctology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Recovery (Medical)</topic><topic>Review</topic><topic>Surgery</topic><topic>Well being</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lu, Justin</creatorcontrib><creatorcontrib>Khamar, Jigish</creatorcontrib><creatorcontrib>McKechnie, Tyler</creatorcontrib><creatorcontrib>Lee, Yung</creatorcontrib><creatorcontrib>Amin, Nalin</creatorcontrib><creatorcontrib>Hong, Dennis</creatorcontrib><creatorcontrib>Eskicioglu, Cagla</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lu, Justin</au><au>Khamar, Jigish</au><au>McKechnie, Tyler</au><au>Lee, Yung</au><au>Amin, Nalin</au><au>Hong, Dennis</au><au>Eskicioglu, Cagla</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative carbohydrate loading before colorectal surgery: a systematic review and meta-analysis of randomized controlled trials</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2022-12</date><risdate>2022</risdate><volume>37</volume><issue>12</issue><spage>2431</spage><epage>2450</epage><pages>2431-2450</pages><issn>1432-1262</issn><issn>0179-1958</issn><eissn>1432-1262</eissn><abstract>Purpose
Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative carbohydrate loading in colorectal surgery has never been synthesized.
Methods
MEDLINE, Embase, and CENTRAL were searched until May 2021. Randomized controlled trials (RCTs) comparing patients undergoing colorectal surgery with and without preoperative carbohydrate loading were included. Primary outcomes were changes in blood insulin and glucose levels. A pairwise meta-analysis was performed using inverse variance random effects.
Results
The search yielded 3656 citations, from which 12 RCTs were included. In total, 387 patients given preoperative carbohydrate loading (47.2% female, age: 62.0 years) and 371 patients in control groups (49.4% female, age: 61.1 years) were included. There was no statistical difference for blood glucose and insulin levels between both patient groups. Patients receiving preoperative carbohydrate loading experienced a shorter time to first flatus (SMD: − 0.48 days, 95% CI: − 0.84 to − 0.12,
p
= 0.008) and stool (SMD: − 0.50 days, 95% CI: − 0.86 to − 0.14,
p
= 0.007). Additionally, length of stay was shorter in the preoperative carbohydrate loading group (SMD: − 0.51 days, 95% CI: − 0.88 to − 0.14,
p
= 0.007). There was no difference in postoperative morbidity and patient well-being between both groups.
Conclusions
Preoperative carbohydrate loading does not significantly impact postoperative glycemic control in patients undergoing colorectal surgery; however, it may be associated with a shorter length of stay and faster return of bowel function. It merits consideration for inclusion within colorectal enhanced recovery after surgery protocols.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>36472671</pmid><doi>10.1007/s00384-022-04288-3</doi><tpages>20</tpages></addata></record> |
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source | MEDLINE; SpringerNature Journals |
subjects | Analysis Blood glucose Blood sugar Carbohydrates Clinical trials Colorectal Surgery Diet, Carbohydrate Loading - methods Female Gastroenterology Hepatology Humans Insulin Internal Medicine Length of Stay Male Medicine Medicine & Public Health Meta-analysis Middle Aged Morbidity Patients Postoperative Complications Preoperative Care - methods Proctology Randomized Controlled Trials as Topic Recovery (Medical) Review Surgery Well being |
title | Preoperative carbohydrate loading before colorectal surgery: a systematic review and meta-analysis of randomized controlled trials |
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