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
Hauptverfasser: Lu, Justin, Khamar, Jigish, McKechnie, Tyler, Lee, Yung, Amin, Nalin, Hong, Dennis, Eskicioglu, Cagla
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container_end_page 2450
container_issue 12
container_start_page 2431
container_title International journal of colorectal disease
container_volume 37
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
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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 &amp; 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. 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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. 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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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