Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery

Background and aim: Preoperative fasting leads to metabolic stress and causes insulin resistance in patients undergoing cardiac surgery. The aim of this study was to assess the effect of preoperative oral carbohydrate loading (OCH) on outcome in patients undergoing planned cardiac surgery by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods: Systematic search of PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was performed to identify relevant RCTs from databased inception until 05/03/2020. We included studies that compared outcome measures between OCH with control (placebo or standard starvation). We conducted a random-effect meta-analysis of clinical and biochemical parameters. Results: Nine studies (N = 9) were included with a total of 507 patients. OCH significantly decreased aortic clamping duration (n = 151, standardized mean difference (SMD) = −0.28, 95% confidence interval (CI) = −0.521 to −0.038, p = 0.023 and differences in means (DM) = −6.388, 95%CI = −11.246 to −1.529, p = 0.010). Patients from treatment groups had shorter intensive care unit (ICU) stay (n = 202, SMD = −0.542, 95%CI = −0.789 to −0.295, p < 0.001 and DM = −25.925, 95%CI = −44.568 to −7.283, p = 0.006) and required fewer units of insulin postoperatively (n = 85, SMD = −0.349, 95%CI = −0.653 to −0.044, p = 0.025 and DM = −4.523, 95%CI = −8.417 to −0.630, p = 0.023). The necessity to use inotropic drugs was significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI = 0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a significant effect. Conclusions: Preoperative OCH in patients undergoing cardiac surgery demonstrated a 20% reduction in the use of inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease in aortic clamping duration and a 35% decrease of postoperative insulin requirement.

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Abbreviated Perioperative Fasting Management for Elective Fresh Fracture Surgery: Guideline Adherence Analysis

10.21203/rs.3.rs-1114717/v1 ◽

2022 ◽

Author(s):

Zhi-jian Sun ◽

Xu Sun ◽

Yan Huo ◽

Meng Mi ◽

Gui-ling Peng ◽

...

Keyword(s):

Elective Surgery ◽

Compliance Rate ◽

Perioperative Period ◽

Preoperative Fasting ◽

Oral Nutrition ◽

Carbohydrate Loading ◽

Fasting Time ◽

Clinical Practice Setting ◽

Preoperative Carbohydrate Loading ◽

Nutrition Intake

Abstract BackgroundLong-term fasting for elective surgery has been proven unnecessary based on established guidelines. Instead, preoperative carbohydrate loading 2 hours before surgery and recommencing oral nutrition intake as soon as possible after surgery is recommended. This study was performed to analyze the compliance with and effect of abbreviated perioperative fasting management in patients undergoing surgical repair of fresh fractures based on current guidelines.MethodsPatients with fresh fractures were consecutively enrolled from May 2019 to July 2019 at our hospital. A carbohydrate-enriched beverage was recommended up to 2 hours before surgery for all surgical patients except those with contraindications. Postoperatively, oral clear liquids were allowed once the patients had regained full consciousness, and solid food was allowed 1 to 2 hours later according to the patients’ willingness. The perioperative fasting time was recorded and the patients’ subjective comfort with respect to thirst and hunger was assessed using an interview-assisted questionnaire.ResultsIn total, 306 patients were enrolled in this study. The compliance rate of preoperative carbohydrate loading was 71.6%, and 93.5% of patients began ingestion of oral liquids within 2 hours after surgery. The median (interquartile range) preoperative fasting time for liquids and solids was 8 (5.2–12.9) and 19 (15.7–22) hours, respectively. The median postoperative fasting time for liquids and solids was 1 (0.5–1.9) and 2.8 (2.2–3.5) hours, respectively. A total of 70.3% and 74.2% of patients reported no thirst or hunger during the perioperative period. Logistic regression analysis showed that the preoperative fasting time for liquids was an independent risk factor for perioperative hunger. No adverse events such as aspiration pneumonia or gastroesophageal reflux were observed.ConclusionsIn this study of a real clinical practice setting, abbreviated perioperative fasting management was carried out with high compliance in patients with fresh fractures. The preoperative fasting time should be further shortened to further improve patients’ subjective comfort.

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Preoperative carbohydrate loading before elective abdominal surgery: a systematic review and network meta-analysis of phase II/III randomized controlled trials

Clinical Nutrition ◽

10.1016/j.clnu.2021.12.016 ◽

2021 ◽

Author(s):

Claudio Ricci ◽

Carlo Ingaldi ◽

Laura Alberici ◽

Francesco Serbassi ◽

Nico Pagano ◽

...

Keyword(s):

Systematic Review ◽

Abdominal Surgery ◽

Randomized Controlled Trials ◽

Phase Ii ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Carbohydrate Loading ◽

Elective Abdominal Surgery ◽

Preoperative Carbohydrate Loading

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Reply to: “Preoperative Carbohydrate Loading on Outcomes after Cardiac Surgery: A Flawed Meta-Analysis. Comment on: The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients 2020, 12, 3904”

Nutrients ◽

10.3390/nu12123905 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3905

Author(s):

Katarzyna Kotfis ◽

Dominika Jamioł-Milc ◽

Karolina Skonieczna-Żydecka ◽

Marcin Folwarski ◽

Ewa Stachowska

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Randomized Trials ◽

Meta Analysis ◽

Carbohydrate Loading ◽

Preoperative Carbohydrate Loading

We appreciate the thoughts and questions posed by Drs Dileep N Lobo and Girish P Joshi [...]

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Faculty Opinions recommendation of A meta-analysis of probiotic and synbiotic use in elective surgery: does nutrition modulation of the gut microbiome improve clinical outcome?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717953489.793460764 ◽

2012 ◽

Author(s):

Kim Barrett

Keyword(s):

Clinical Outcome ◽

Gut Microbiome ◽

Elective Surgery ◽

Meta Analysis ◽

Improve Clinical Outcome

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Effectiveness and safety of nasogastric decompression after elective surgery for colon and rectum neoplasms: a meta-analysis

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2012.00292 ◽

2012 ◽

Vol 32 (3) ◽

pp. 292-297 ◽

Cited By ~ 1

Author(s):

Hong LIU ◽

Chun-yi WANG ◽

Jiang QIAN ◽

Zhong-xue FU

Keyword(s):

Elective Surgery ◽

Meta Analysis ◽

Colon And Rectum ◽

Nasogastric Decompression

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Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10061276 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1276

Author(s):

Volker Schick ◽

Fabian Dusse ◽

Ronny Eckardt ◽

Steffen Kerkhoff ◽

Simone Commotio ◽

...

Keyword(s):

Systematic Review ◽

Elective Surgery ◽

Meta Analysis ◽

Lung Ventilation ◽

One Lung Ventilation ◽

Controlled Ventilation ◽

Pressure Controlled Ventilation ◽

Volume Controlled Ventilation ◽

Volume Controlled ◽

Pressure Controlled

For perioperative mechanical ventilation under general anesthesia, modern respirators aim at combining the benefits of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in modes typically named “volume-guaranteed” or “volume-targeted” pressure-controlled ventilation (PCV-VG). This systematic review and meta-analysis tested the hypothesis that PCV-VG modes of ventilation could be beneficial in terms of improved airway pressures (Ppeak, Pplateau, Pmean), dynamic compliance (Cdyn), or arterial blood gases (PaO2, PaCO2) in adults undergoing elective surgery under general anesthesia. Three major medical electronic databases were searched with predefined search strategies and publications were systematically evaluated according to the Cochrane Review Methods. Continuous variables were tested for mean differences using the inverse variance method and 95% confidence intervals (CI) were calculated. Based on the assumption that intervention effects across studies were not identical, a random effects model was chosen. Assessment for heterogeneity was performed with the χ2 test and the I2 statistic. As primary endpoints, Ppeak, Pplateau, Pmean, Cdyn, PaO2, and PaCO2 were evaluated. Of the 725 publications identified, 17 finally met eligibility criteria, with a total of 929 patients recruited. Under supine two-lung ventilation, PCV-VG resulted in significantly reduced Ppeak (15 studies) and Pplateau (9 studies) as well as higher Cdyn (9 studies), compared with VCV [random effects models; Ppeak: CI −3.26 to −1.47; p < 0.001; I2 = 82%; Pplateau: −3.12 to −0.12; p = 0.03; I2 = 90%; Cdyn: CI 3.42 to 8.65; p < 0.001; I2 = 90%]. For one-lung ventilation (8 studies), PCV-VG allowed for significantly lower Ppeak and higher PaO2 compared with VCV. In Trendelenburg position (5 studies), this effect was significant for Ppeak only. This systematic review and meta-analysis demonstrates that volume-targeting, pressure-controlled ventilation modes may provide benefits with respect to the improved airway dynamics in two- and one-lung ventilation, and improved oxygenation in one-lung ventilation in adults undergoing elective surgery.

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