Skip to main content
Erschienen in: European Surgery 4/2017

01.08.2017 | original scientific paper

Effects of preoperative carbohydrate drinks on postoperative outcome after colorectal surgery

verfasst von: Zuzana Adamova, Radim Slováček

Erschienen in: European Surgery | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Summary

Background

Overnight fasting before surgery used to be the routine. Overnight fasting changes patients’ metabolic state and influences their perioperative stress response. The aim of the study was to investigate the effects of preoperative carbohydrate drinks on return of bowel sounds and movement, postoperative complications, and length of stay.

Methods

It is a prospective non-randomized study with 196 consecutive patients who underwent surgery in Vsetin hospital for a diagnosis of colon or rectal cancer from January 2010 to January 2015. Patients were assigned into two groups – with (PreOp group) and without (Non-PreOp group) carbohydrate drink. We collected data regarding age, comorbidities, local stage of tumor, urgency and type of operation. The output variables recorded included postoperative bowel sounds, first stool, postoperative complications, anastomotic leak, surgical site infections, and length of hospital stay.

Results

In the PreOp group there was faster return of peristalsis (p = 0,033). We did not prove that the PreOp influenced passage of stool. The total number of postoperative complications was higher in the Non-PreOp group than in the PreOp group, 57 (57%) vs. 30 (31%) respectively, (p = 0,0003). The most frequent type of complication was surgical site infection (SSI). It occurred in 17% in the PreOp group and in 34% in the Non-PreOp group (p = 0,004). The difference in anastomotic leak rate was not significant. Mean hospital stay was 13 days in the PreOp group and 16 days in the Non-PreOp group (p = 0,006).

Conclusion

Use of carbohydrate solution before the surgery accelerates return of bowel sounds, reduces total number of postoperative complications, SSI and shortens the length of hospital stay. Carbohydrate beverages should be used more widely in daily practice.
Literatur
1.
2.
Zurück zum Zitat Ryska O, Serclova Z, Antos F. Compliance with the procedures of modern perioperative care (enhanced recovery after surgery) at surgery departments in the Czech Republic - results of a national survey. Rozhl Chir. 2013;92(8):435–42.PubMed Ryska O, Serclova Z, Antos F. Compliance with the procedures of modern perioperative care (enhanced recovery after surgery) at surgery departments in the Czech Republic - results of a national survey. Rozhl Chir. 2013;92(8):435–42.PubMed
3.
Zurück zum Zitat Yagci G, Can MF, Ozturk E, et al. Effects of pre-operative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: a randomized, controlled trial. Nutrition. 2008;24(3):212–6.CrossRefPubMed Yagci G, Can MF, Ozturk E, et al. Effects of pre-operative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: a randomized, controlled trial. Nutrition. 2008;24(3):212–6.CrossRefPubMed
4.
Zurück zum Zitat Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg. 1995;222(6):728–34.CrossRefPubMedPubMedCentral Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg. 1995;222(6):728–34.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Nygren J, Soop M, Thorell A, Efendic S, Nair KS, Ljungqvist O. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr. 1998;17(2):65–71.CrossRefPubMed Nygren J, Soop M, Thorell A, Efendic S, Nair KS, Ljungqvist O. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr. 1998;17(2):65–71.CrossRefPubMed
6.
Zurück zum Zitat Faria MS, de Aguilar-Nascimento JE, Pimenta OS, Alvarenga LC Jr, Dock-Nascimento DB, Slhessarenko N. Preoperative fasting of 2 hours minimizes insulin resistance and organic response to trauma after video-cholecystectomy: a randomized, controlled, clinical trial. World J Surg. 2009;33(6):1158–64.CrossRefPubMed Faria MS, de Aguilar-Nascimento JE, Pimenta OS, Alvarenga LC Jr, Dock-Nascimento DB, Slhessarenko N. Preoperative fasting of 2 hours minimizes insulin resistance and organic response to trauma after video-cholecystectomy: a randomized, controlled, clinical trial. World J Surg. 2009;33(6):1158–64.CrossRefPubMed
7.
Zurück zum Zitat Yagmurdur H, Gunal S, Yildiz H, Gulec H, Topkaya C. The effects of carbohydrate-rich drink on perioperative discomfort, insulin response and arterial pressure in spinal aesthesia. J Res Med Sci. 2011;16(11):1483–9.PubMedPubMedCentral Yagmurdur H, Gunal S, Yildiz H, Gulec H, Topkaya C. The effects of carbohydrate-rich drink on perioperative discomfort, insulin response and arterial pressure in spinal aesthesia. J Res Med Sci. 2011;16(11):1483–9.PubMedPubMedCentral
8.
Zurück zum Zitat Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am J Physiol Endocrinol Metab. 2001;280(4):E576–E83.PubMed Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am J Physiol Endocrinol Metab. 2001;280(4):E576–E83.PubMed
9.
Zurück zum Zitat Ljunggren S, Hahn RG. Oral nutrition or water loading before hip replacement surgery; a randomized clinical trial. Trials. 2012;2(13):97.CrossRef Ljunggren S, Hahn RG. Oral nutrition or water loading before hip replacement surgery; a randomized clinical trial. Trials. 2012;2(13):97.CrossRef
10.
Zurück zum Zitat Ljunggren S, Hahn RG, Nyström T. Insulin sensitivity and beta-cell function after carbohydrate oral loading in hip replacement surgery: a double-blind, randomised controlled clinical trial. Clin Nutr. 2014;33(3):392–8.CrossRefPubMed Ljunggren S, Hahn RG, Nyström T. Insulin sensitivity and beta-cell function after carbohydrate oral loading in hip replacement surgery: a double-blind, randomised controlled clinical trial. Clin Nutr. 2014;33(3):392–8.CrossRefPubMed
11.
Zurück zum Zitat Rapp-Kesek D, Stridsberg M, Andersson LG, Berne C, Karlsson T. Insulin resistance after cardiopulmonary bypass in the elderly patient. Scand Cardiovasc J. 2007;41(2):102–8.CrossRefPubMed Rapp-Kesek D, Stridsberg M, Andersson LG, Berne C, Karlsson T. Insulin resistance after cardiopulmonary bypass in the elderly patient. Scand Cardiovasc J. 2007;41(2):102–8.CrossRefPubMed
12.
Zurück zum Zitat Breuer JP, von Dossow V, von Heymann C, et al. Preoperative oral carbohydrate administration to ASA III–IV patients undergoing elective cardiac surgery. Anesth Analg. 2006;103(5):1099–108.CrossRefPubMed Breuer JP, von Dossow V, von Heymann C, et al. Preoperative oral carbohydrate administration to ASA III–IV patients undergoing elective cardiac surgery. Anesth Analg. 2006;103(5):1099–108.CrossRefPubMed
13.
Zurück zum Zitat Gjessing PF, Hagve M, Fuskevåg OM, Revhaug A, Irtun Ø. Single-dose carbohydrate treatment in the immediate preoperative phase diminishes development of postoperative peripheral insulin resistance. Clin Nutr. 2015;34(1):156–64.CrossRefPubMed Gjessing PF, Hagve M, Fuskevåg OM, Revhaug A, Irtun Ø. Single-dose carbohydrate treatment in the immediate preoperative phase diminishes development of postoperative peripheral insulin resistance. Clin Nutr. 2015;34(1):156–64.CrossRefPubMed
14.
Zurück zum Zitat Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg. 2001;93(5):44–50.CrossRef Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg. 2001;93(5):44–50.CrossRef
15.
Zurück zum Zitat Yilmaz N, Çekmen N, Bilgin F, Erten E, Özhan M, Ahmet Coşar A. Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting. J Res Med Sci. 2013;18(10):827–32.PubMedPubMedCentral Yilmaz N, Çekmen N, Bilgin F, Erten E, Özhan M, Ahmet Coşar A. Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting. J Res Med Sci. 2013;18(10):827–32.PubMedPubMedCentral
16.
Zurück zum Zitat Singh BN, Dahiya D, Bagaria D, et al. Effects of preoperative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy. Surg Endosc. 2015;29(11):3267–72.CrossRefPubMed Singh BN, Dahiya D, Bagaria D, et al. Effects of preoperative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy. Surg Endosc. 2015;29(11):3267–72.CrossRefPubMed
17.
Zurück zum Zitat Bopp C, Hofer S, Klein A, et al. A liberal preoperative fasting regimen improves patient comfort and satisfaction with anesthesia care in day-stay minor surgery. Minerva Anestesiol. 2011;77(7):680–6.PubMed Bopp C, Hofer S, Klein A, et al. A liberal preoperative fasting regimen improves patient comfort and satisfaction with anesthesia care in day-stay minor surgery. Minerva Anestesiol. 2011;77(7):680–6.PubMed
18.
Zurück zum Zitat Wang ZG, Wang Q, Wang WJ, Qin HL. Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg. 2010;97(3):317–27.CrossRefPubMed Wang ZG, Wang Q, Wang WJ, Qin HL. Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg. 2010;97(3):317–27.CrossRefPubMed
19.
Zurück zum Zitat Ajuzieogu OV, Amucheazi AO, Nwagha UI, Ezike HA, Luka SK, Abam DS. Effect of routine preoperative fasting on residual gastric volume and acid in patients undergoing myomectomy. Niger J Clin Pract. 2016;19(6):816–20.CrossRefPubMed Ajuzieogu OV, Amucheazi AO, Nwagha UI, Ezike HA, Luka SK, Abam DS. Effect of routine preoperative fasting on residual gastric volume and acid in patients undergoing myomectomy. Niger J Clin Pract. 2016;19(6):816–20.CrossRefPubMed
20.
Zurück zum Zitat Bisgaard T, Kristiansen VB, Hjortsø NC, Jacobsen LS, Rosenberg J, Kehlet H. Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy. Br J Surg. 2004;91(2):151–8.CrossRefPubMed Bisgaard T, Kristiansen VB, Hjortsø NC, Jacobsen LS, Rosenberg J, Kehlet H. Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy. Br J Surg. 2004;91(2):151–8.CrossRefPubMed
21.
Zurück zum Zitat Luttikhold J, Oosting A, van den Braak CC, et al. Preservation of the gut by preoperative carbohydrate loading improves postoperative food intake. Clin Nutr. 2013;32(4):556–61.CrossRefPubMed Luttikhold J, Oosting A, van den Braak CC, et al. Preservation of the gut by preoperative carbohydrate loading improves postoperative food intake. Clin Nutr. 2013;32(4):556–61.CrossRefPubMed
22.
Zurück zum Zitat Gündoğdu RH, Yaşar U, Ersoy PE, Ergül E, Işıkoğlu S, Erhan A. Effects of preoperative nutritional support on colonic anastomotic healing in malnourished rats. Ulus Cerrahi Derg. 2015;31(3):113–7.PubMedPubMedCentral Gündoğdu RH, Yaşar U, Ersoy PE, Ergül E, Işıkoğlu S, Erhan A. Effects of preoperative nutritional support on colonic anastomotic healing in malnourished rats. Ulus Cerrahi Derg. 2015;31(3):113–7.PubMedPubMedCentral
23.
Zurück zum Zitat Protić A, Bobinac M, Ivancić A, Zuvić-Butorac M, Sustis A, Jakljevic T. Effect of preoperative feeding on gallbladder size and peristaltic of the small bowel following spinal anesthesia for the hip surgery. Coll Antropol. 2010;34(Suppl 2):195–8.PubMed Protić A, Bobinac M, Ivancić A, Zuvić-Butorac M, Sustis A, Jakljevic T. Effect of preoperative feeding on gallbladder size and peristaltic of the small bowel following spinal anesthesia for the hip surgery. Coll Antropol. 2010;34(Suppl 2):195–8.PubMed
24.
Zurück zum Zitat Noblett SE, Watson DS, Huong H, et al. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis. 2006;8(7):563–9.CrossRefPubMed Noblett SE, Watson DS, Huong H, et al. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis. 2006;8(7):563–9.CrossRefPubMed
25.
Zurück zum Zitat Kaska M, Grosmanova T, Havel E, et al. The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery – a randomized controlled trial. Wien Klin Wochenschr. 2010;122(1–2):23–30.CrossRefPubMed Kaska M, Grosmanova T, Havel E, et al. The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery – a randomized controlled trial. Wien Klin Wochenschr. 2010;122(1–2):23–30.CrossRefPubMed
26.
Zurück zum Zitat Yuill KA, Richardson RA, Davidson HI, Garden OJ, Parks RW. The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively – a randomised clinical trial. Clin Nutr. 2005;24(1):32–7.CrossRefPubMed Yuill KA, Richardson RA, Davidson HI, Garden OJ, Parks RW. The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively – a randomised clinical trial. Clin Nutr. 2005;24(1):32–7.CrossRefPubMed
27.
Zurück zum Zitat Amer MA, Smith MD, Herbison G, Plank LD, McCall JL. Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery. Br J Surg. 2017;104(3):187–97.CrossRefPubMed Amer MA, Smith MD, Herbison G, Plank LD, McCall JL. Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery. Br J Surg. 2017;104(3):187–97.CrossRefPubMed
28.
Zurück zum Zitat Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev. 2014; . doi:10.1002/14651858.CD009161.pub2. Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev. 2014; . doi:10.​1002/​14651858.​CD009161.​pub2.
29.
Zurück zum Zitat Gunerhan Y, Koksal N, Sahin UY, Uzun MA, Ekşioglu-Demiralp E. Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters. World J Gastroenterol. 2009;15(4):467–72.CrossRefPubMedPubMedCentral Gunerhan Y, Koksal N, Sahin UY, Uzun MA, Ekşioglu-Demiralp E. Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters. World J Gastroenterol. 2009;15(4):467–72.CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Mathur S, Plank LD, McCall JL, et al. Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Br J Surg. 2010;97(4):485–94.CrossRefPubMed Mathur S, Plank LD, McCall JL, et al. Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Br J Surg. 2010;97(4):485–94.CrossRefPubMed
31.
Zurück zum Zitat Webster J, Osborne SR, Gill R, et al. Does preoperative oral carbohydrate reduce hospital stay? A randomized trial. AORN J. 2014;99(2):233–42.CrossRefPubMed Webster J, Osborne SR, Gill R, et al. Does preoperative oral carbohydrate reduce hospital stay? A randomized trial. AORN J. 2014;99(2):233–42.CrossRefPubMed
32.
Zurück zum Zitat Pexe-Machado PA, de Oliveira BD, Dock-Nascimento DB, de Aguilar-Nascimento JE. Shrinking preoperative fast time with maltodextrin and protein hydrolysate in gastrointestinal resections due to cancer. Nutrition. 2013;29(7–8):1054–9.CrossRefPubMed Pexe-Machado PA, de Oliveira BD, Dock-Nascimento DB, de Aguilar-Nascimento JE. Shrinking preoperative fast time with maltodextrin and protein hydrolysate in gastrointestinal resections due to cancer. Nutrition. 2013;29(7–8):1054–9.CrossRefPubMed
Metadaten
Titel
Effects of preoperative carbohydrate drinks on postoperative outcome after colorectal surgery
verfasst von
Zuzana Adamova
Radim Slováček
Publikationsdatum
01.08.2017
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2017
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-017-0485-x

Weitere Artikel der Ausgabe 4/2017

European Surgery 4/2017 Zur Ausgabe