A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery
Summary Background & aims Whilst preoperative carbohydrate treatment (PCT) results in beneficial physiological effects, the effects on postoperative clinical outcomes remain unclear and were studied in this meta-analysis. Methods Prospective studies that randomised adult non-diabetic patients to...
Gespeichert in:
| Veröffentlicht in: | Clinical nutrition (Edinburgh, Scotland) Scotland), 2013-02, Vol.32 (1), p.34-44 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 44 |
|---|---|
| container_issue | 1 |
| container_start_page | 34 |
| container_title | Clinical nutrition (Edinburgh, Scotland) |
| container_volume | 32 |
| creator | Awad, Sherif Varadhan, Krishna K Ljungqvist, Olle Lobo, Dileep N |
| description | Summary Background & aims Whilst preoperative carbohydrate treatment (PCT) results in beneficial physiological effects, the effects on postoperative clinical outcomes remain unclear and were studied in this meta-analysis. Methods Prospective studies that randomised adult non-diabetic patients to either PCT (≥50 g oral carbohydrates 2–4 h pre-anaesthesia) or control (fasted/placebo) were included. The primary outcome was length of hospital stay. Secondary outcomes included development of postoperative insulin resistance, complications, nausea and vomiting. Methodological quality was assessed using GRADEpro® software. Results Twenty-one randomised studies of 1685 patients (733 PCT: 952 control) were included. No overall difference in length of stay was noted for analysis of all studies or subgroups of patients undergoing surgery with an expected hospital stay ≤2 days or orthopaedic procedures. However, patients undergoing major abdominal surgery following PCT had reduced length of stay [mean difference, 95% confidence interval: −1.08 (−1.87 to −0.29); I2 = 60%, p = 0.007]. PCT reduced postoperative insulin resistance with no effects on in-hospital complications over control (risk ratio, 95% confidence interval, 0.88 (0.50–1.53), I2 = 41%; p = 0.640). There was significant heterogeneity amongst studies and, therefore, quality of evidence was low to moderate. Conclusions PCT may be associated with reduced length of stay in patients undergoing major abdominal surgery, however, the included studies were of low to moderate quality. |
| doi_str_mv | 10.1016/j.clnu.2012.10.011 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_533039</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0261561412002269</els_id><sourcerecordid>1273692178</sourcerecordid><originalsourceid>FETCH-LOGICAL-c634t-3cf39d77216c18a26704205b00ca60e455b997c9855e379ee544c48b2015f8d43</originalsourceid><addsrcrecordid>eNp9kktr3DAUhU1paSZp_0AXrTeFLOqpHpZsQSkM6RMCXaTpVsjy9VQTjeVIdsr8-15nJgkU0oWQuPrOQbr3ZNkrSpaUUPl-s7S-n5aMUIaFJaH0SbaggrOCqpo_zRaESVoIScuj7DilDSFE8Kp-nh0xzgiqykUWVvkWRlOY3vhdcikPXR5N34atS9DmNvRjDN7jcYzOeLzv8yFCGCCa0d1AHqLxuTWxCb93LdYAQTDjFvoxd30OHuwtl6a4hrh7kT3r0AZeHvaT7PLL559n34rzH1-_n63OCyt5ORbcdly1VcWotLQ2TFakZEQ0hFgjCZRCNEpVVtVCAK8UgChLW9YN9kJ0dVvyk6zY-6Y_MEyNHqLbmrjTwTh9KF3hCbTgnHCFvHqUH2JoH0R3QsokozXhNWrfPar95H6tdIhrXJNmFbvFT_c4-l5PkEaNvbbgvekhTAmNKy4Vo9WMsj1qY0gpQnfvTYmeM6A3es6AnjMw1zADKHp98J-aLbT3kruhI_D2AJhkje9w3talB07WgtSKIPdmz3UmaLOOyFxezB3GIFWKqdnpw54AHOWNg6iTddBbaF3Eues2uP-_9OM_cutd7_BNV7CDtAlTxFhiR3RimuiLOc9znCl-hDGp-F-tye_M</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1273692178</pqid></control><display><type>article</type><title>A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Awad, Sherif ; Varadhan, Krishna K ; Ljungqvist, Olle ; Lobo, Dileep N</creator><creatorcontrib>Awad, Sherif ; Varadhan, Krishna K ; Ljungqvist, Olle ; Lobo, Dileep N</creatorcontrib><description>Summary Background & aims Whilst preoperative carbohydrate treatment (PCT) results in beneficial physiological effects, the effects on postoperative clinical outcomes remain unclear and were studied in this meta-analysis. Methods Prospective studies that randomised adult non-diabetic patients to either PCT (≥50 g oral carbohydrates 2–4 h pre-anaesthesia) or control (fasted/placebo) were included. The primary outcome was length of hospital stay. Secondary outcomes included development of postoperative insulin resistance, complications, nausea and vomiting. Methodological quality was assessed using GRADEpro® software. Results Twenty-one randomised studies of 1685 patients (733 PCT: 952 control) were included. No overall difference in length of stay was noted for analysis of all studies or subgroups of patients undergoing surgery with an expected hospital stay ≤2 days or orthopaedic procedures. However, patients undergoing major abdominal surgery following PCT had reduced length of stay [mean difference, 95% confidence interval: −1.08 (−1.87 to −0.29); I2 = 60%, p = 0.007]. PCT reduced postoperative insulin resistance with no effects on in-hospital complications over control (risk ratio, 95% confidence interval, 0.88 (0.50–1.53), I2 = 41%; p = 0.640). There was significant heterogeneity amongst studies and, therefore, quality of evidence was low to moderate. Conclusions PCT may be associated with reduced length of stay in patients undergoing major abdominal surgery, however, the included studies were of low to moderate quality.</description><identifier>ISSN: 0261-5614</identifier><identifier>ISSN: 1532-1983</identifier><identifier>EISSN: 1532-1983</identifier><identifier>DOI: 10.1016/j.clnu.2012.10.011</identifier><identifier>PMID: 23200124</identifier><identifier>CODEN: CLNUDP</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Abdomen - surgery ; adults ; Biological and medical sciences ; carbohydrates ; Complications ; computer software ; confidence interval ; Dietary Carbohydrates - therapeutic use ; Elective Surgical Procedures - adverse effects ; Evidence-Based Medicine ; Feeding. Feeding behavior ; Fundamental and applied biological sciences. Psychology ; Gastroenterology and Hepatology ; Hospital stay ; Humans ; Insulin Resistance ; Length of Stay ; Medicin ; Medicin och hälsovetenskap ; Medicine ; Meta-analysis ; nausea ; Oral carbohydrate ; orthopedics ; patients ; Postoperative Complications - prevention & control ; Postoperative Nausea and Vomiting - prevention & control ; Preoperative Care ; prospective studies ; randomized clinical trials ; Randomized Controlled Trials as Topic ; relative risk ; Surgery ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; vomiting</subject><ispartof>Clinical nutrition (Edinburgh, Scotland), 2013-02, Vol.32 (1), p.34-44</ispartof><rights>Elsevier Ltd and European Society for Clinical Nutrition and Metabolism</rights><rights>2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c634t-3cf39d77216c18a26704205b00ca60e455b997c9855e379ee544c48b2015f8d43</citedby><cites>FETCH-LOGICAL-c634t-3cf39d77216c18a26704205b00ca60e455b997c9855e379ee544c48b2015f8d43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.clnu.2012.10.011$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,315,781,785,886,3551,27928,27929,45999</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26850890$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23200124$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-27238$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:126218038$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Awad, Sherif</creatorcontrib><creatorcontrib>Varadhan, Krishna K</creatorcontrib><creatorcontrib>Ljungqvist, Olle</creatorcontrib><creatorcontrib>Lobo, Dileep N</creatorcontrib><title>A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery</title><title>Clinical nutrition (Edinburgh, Scotland)</title><addtitle>Clin Nutr</addtitle><description>Summary Background & aims Whilst preoperative carbohydrate treatment (PCT) results in beneficial physiological effects, the effects on postoperative clinical outcomes remain unclear and were studied in this meta-analysis. Methods Prospective studies that randomised adult non-diabetic patients to either PCT (≥50 g oral carbohydrates 2–4 h pre-anaesthesia) or control (fasted/placebo) were included. The primary outcome was length of hospital stay. Secondary outcomes included development of postoperative insulin resistance, complications, nausea and vomiting. Methodological quality was assessed using GRADEpro® software. Results Twenty-one randomised studies of 1685 patients (733 PCT: 952 control) were included. No overall difference in length of stay was noted for analysis of all studies or subgroups of patients undergoing surgery with an expected hospital stay ≤2 days or orthopaedic procedures. However, patients undergoing major abdominal surgery following PCT had reduced length of stay [mean difference, 95% confidence interval: −1.08 (−1.87 to −0.29); I2 = 60%, p = 0.007]. PCT reduced postoperative insulin resistance with no effects on in-hospital complications over control (risk ratio, 95% confidence interval, 0.88 (0.50–1.53), I2 = 41%; p = 0.640). There was significant heterogeneity amongst studies and, therefore, quality of evidence was low to moderate. Conclusions PCT may be associated with reduced length of stay in patients undergoing major abdominal surgery, however, the included studies were of low to moderate quality.</description><subject>Abdomen - surgery</subject><subject>adults</subject><subject>Biological and medical sciences</subject><subject>carbohydrates</subject><subject>Complications</subject><subject>computer software</subject><subject>confidence interval</subject><subject>Dietary Carbohydrates - therapeutic use</subject><subject>Elective Surgical Procedures - adverse effects</subject><subject>Evidence-Based Medicine</subject><subject>Feeding. Feeding behavior</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Gastroenterology and Hepatology</subject><subject>Hospital stay</subject><subject>Humans</subject><subject>Insulin Resistance</subject><subject>Length of Stay</subject><subject>Medicin</subject><subject>Medicin och hälsovetenskap</subject><subject>Medicine</subject><subject>Meta-analysis</subject><subject>nausea</subject><subject>Oral carbohydrate</subject><subject>orthopedics</subject><subject>patients</subject><subject>Postoperative Complications - prevention & control</subject><subject>Postoperative Nausea and Vomiting - prevention & control</subject><subject>Preoperative Care</subject><subject>prospective studies</subject><subject>randomized clinical trials</subject><subject>Randomized Controlled Trials as Topic</subject><subject>relative risk</subject><subject>Surgery</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>vomiting</subject><issn>0261-5614</issn><issn>1532-1983</issn><issn>1532-1983</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kktr3DAUhU1paSZp_0AXrTeFLOqpHpZsQSkM6RMCXaTpVsjy9VQTjeVIdsr8-15nJgkU0oWQuPrOQbr3ZNkrSpaUUPl-s7S-n5aMUIaFJaH0SbaggrOCqpo_zRaESVoIScuj7DilDSFE8Kp-nh0xzgiqykUWVvkWRlOY3vhdcikPXR5N34atS9DmNvRjDN7jcYzOeLzv8yFCGCCa0d1AHqLxuTWxCb93LdYAQTDjFvoxd30OHuwtl6a4hrh7kT3r0AZeHvaT7PLL559n34rzH1-_n63OCyt5ORbcdly1VcWotLQ2TFakZEQ0hFgjCZRCNEpVVtVCAK8UgChLW9YN9kJ0dVvyk6zY-6Y_MEyNHqLbmrjTwTh9KF3hCbTgnHCFvHqUH2JoH0R3QsokozXhNWrfPar95H6tdIhrXJNmFbvFT_c4-l5PkEaNvbbgvekhTAmNKy4Vo9WMsj1qY0gpQnfvTYmeM6A3es6AnjMw1zADKHp98J-aLbT3kruhI_D2AJhkje9w3talB07WgtSKIPdmz3UmaLOOyFxezB3GIFWKqdnpw54AHOWNg6iTddBbaF3Eues2uP-_9OM_cutd7_BNV7CDtAlTxFhiR3RimuiLOc9znCl-hDGp-F-tye_M</recordid><startdate>20130201</startdate><enddate>20130201</enddate><creator>Awad, Sherif</creator><creator>Varadhan, Krishna K</creator><creator>Ljungqvist, Olle</creator><creator>Lobo, Dileep N</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>FBQ</scope><scope>IQODW</scope><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>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D91</scope></search><sort><creationdate>20130201</creationdate><title>A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery</title><author>Awad, Sherif ; Varadhan, Krishna K ; Ljungqvist, Olle ; Lobo, Dileep N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c634t-3cf39d77216c18a26704205b00ca60e455b997c9855e379ee544c48b2015f8d43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abdomen - surgery</topic><topic>adults</topic><topic>Biological and medical sciences</topic><topic>carbohydrates</topic><topic>Complications</topic><topic>computer software</topic><topic>confidence interval</topic><topic>Dietary Carbohydrates - therapeutic use</topic><topic>Elective Surgical Procedures - adverse effects</topic><topic>Evidence-Based Medicine</topic><topic>Feeding. Feeding behavior</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Gastroenterology and Hepatology</topic><topic>Hospital stay</topic><topic>Humans</topic><topic>Insulin Resistance</topic><topic>Length of Stay</topic><topic>Medicin</topic><topic>Medicin och hälsovetenskap</topic><topic>Medicine</topic><topic>Meta-analysis</topic><topic>nausea</topic><topic>Oral carbohydrate</topic><topic>orthopedics</topic><topic>patients</topic><topic>Postoperative Complications - prevention & control</topic><topic>Postoperative Nausea and Vomiting - prevention & control</topic><topic>Preoperative Care</topic><topic>prospective studies</topic><topic>randomized clinical trials</topic><topic>Randomized Controlled Trials as Topic</topic><topic>relative risk</topic><topic>Surgery</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>vomiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Awad, Sherif</creatorcontrib><creatorcontrib>Varadhan, Krishna K</creatorcontrib><creatorcontrib>Ljungqvist, Olle</creatorcontrib><creatorcontrib>Lobo, Dileep N</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Örebro universitet</collection><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Awad, Sherif</au><au>Varadhan, Krishna K</au><au>Ljungqvist, Olle</au><au>Lobo, Dileep N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery</atitle><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle><addtitle>Clin Nutr</addtitle><date>2013-02-01</date><risdate>2013</risdate><volume>32</volume><issue>1</issue><spage>34</spage><epage>44</epage><pages>34-44</pages><issn>0261-5614</issn><issn>1532-1983</issn><eissn>1532-1983</eissn><coden>CLNUDP</coden><abstract>Summary Background & aims Whilst preoperative carbohydrate treatment (PCT) results in beneficial physiological effects, the effects on postoperative clinical outcomes remain unclear and were studied in this meta-analysis. Methods Prospective studies that randomised adult non-diabetic patients to either PCT (≥50 g oral carbohydrates 2–4 h pre-anaesthesia) or control (fasted/placebo) were included. The primary outcome was length of hospital stay. Secondary outcomes included development of postoperative insulin resistance, complications, nausea and vomiting. Methodological quality was assessed using GRADEpro® software. Results Twenty-one randomised studies of 1685 patients (733 PCT: 952 control) were included. No overall difference in length of stay was noted for analysis of all studies or subgroups of patients undergoing surgery with an expected hospital stay ≤2 days or orthopaedic procedures. However, patients undergoing major abdominal surgery following PCT had reduced length of stay [mean difference, 95% confidence interval: −1.08 (−1.87 to −0.29); I2 = 60%, p = 0.007]. PCT reduced postoperative insulin resistance with no effects on in-hospital complications over control (risk ratio, 95% confidence interval, 0.88 (0.50–1.53), I2 = 41%; p = 0.640). There was significant heterogeneity amongst studies and, therefore, quality of evidence was low to moderate. Conclusions PCT may be associated with reduced length of stay in patients undergoing major abdominal surgery, however, the included studies were of low to moderate quality.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>23200124</pmid><doi>10.1016/j.clnu.2012.10.011</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0261-5614 |
| ispartof | Clinical nutrition (Edinburgh, Scotland), 2013-02, Vol.32 (1), p.34-44 |
| issn | 0261-5614 1532-1983 1532-1983 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_533039 |
| source | MEDLINE; Access via ScienceDirect (Elsevier) |
| subjects | Abdomen - surgery adults Biological and medical sciences carbohydrates Complications computer software confidence interval Dietary Carbohydrates - therapeutic use Elective Surgical Procedures - adverse effects Evidence-Based Medicine Feeding. Feeding behavior Fundamental and applied biological sciences. Psychology Gastroenterology and Hepatology Hospital stay Humans Insulin Resistance Length of Stay Medicin Medicin och hälsovetenskap Medicine Meta-analysis nausea Oral carbohydrate orthopedics patients Postoperative Complications - prevention & control Postoperative Nausea and Vomiting - prevention & control Preoperative Care prospective studies randomized clinical trials Randomized Controlled Trials as Topic relative risk Surgery Vertebrates: anatomy and physiology, studies on body, several organs or systems vomiting |
| title | A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-17T00%3A57%3A25IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20meta-analysis%20of%20randomised%20controlled%20trials%20on%20preoperative%20oral%20carbohydrate%20treatment%20in%20elective%20surgery&rft.jtitle=Clinical%20nutrition%20(Edinburgh,%20Scotland)&rft.au=Awad,%20Sherif&rft.date=2013-02-01&rft.volume=32&rft.issue=1&rft.spage=34&rft.epage=44&rft.pages=34-44&rft.issn=0261-5614&rft.eissn=1532-1983&rft.coden=CLNUDP&rft_id=info:doi/10.1016/j.clnu.2012.10.011&rft_dat=%3Cproquest_swepu%3E1273692178%3C/proquest_swepu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1273692178&rft_id=info:pmid/23200124&rft_els_id=S0261561412002269&rfr_iscdi=true |