2387-PUB: Effect of Pre-op Carb-Loaded Beverage in Bariatric Surgery Patients with Pre-DM and DM as Part of ERAS Protocol

Abstract

The enhanced recovery after surgery (ERAS) protocol is a perioperative care pathway adopted in health systems across the nation as part of quality improvement efforts. A bundle of 20 elements demonstrated improved clinical and financial outcomes. A key element promotes carbohydrate loading a few hours before surgery using beverages such as Boost or ClearFast. There is limited data on pre-DM and DM patients and no clear guidelines on use in these populations. Scripps Health, a large health system in Southern California, adopted the ERAS protocol as a systemwide approach for care improvement in the perioperative process in 2018. Pre-DM and DM patients were represented more commonly in the bariatric surgery group thus providing an opportunity to compare outcomes in these patients receiving a carbohydrate loaded beverage pre and post implementation of the standardized ERAS protocol. We compared N=97 bariatric pre-DM and DM patients who did not receive Clearfast from Jan-Sept 2017 to N=64 bariatric pre-DM and DM patients who received Clearfast from Jan-Sept 2018. See Table 1. Interestingly, in patients with pre-DM and DM, there was a substantial increase in pre-op hyperglycemia but a post-op decrease was noted when a carb-loaded beverage-Clearfast was given to patients prior to bariatric surgery when compared to the previous year when ERAS and carb loading were not part of the perioperative preparation process. Disclosure K.L. Barthelmess: None. L. Talavera: None. A. Philis-Tsimikas: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Dexcom, Inc., Glooko, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. Stock/Shareholder; Spouse/Partner; Ionis Pharmaceuticals, Inc., Novo Nordisk Inc.