Randomised controlled trial on benefits of preoperative carbohydrate loading in patients undergoing elective major hepatobiliary surgery

Abstract

Objective: Surgery induces a catabolic response which is further augmented with prolonged preoperative fasting . Compared to fasting from midnight, preoperative carbohydrate(CHO)-loading attenuates this response and enhances recovery. We aim to assess the effect of CHO-loading on length of hospital stay (LOS), preoperative wellbeing, resting energy expenditure(REE) nutritional status, morbidity and mortality following elective major hepatobiliary operations. Methods: 35 patients were recruited and randomised into control group (fasted) or intervention group (preoperative CHO). 24 patients (12 from each group) were analysed. Preoperative wellbeing on thirst, hunger, dry mouth, anxiety and weakness assessed with VAS (0-10 score). REE, muscle grip strength(MGS), midupper arm circumference(MUAC) measured at baseline (preoperative), postoperative day 1, 4 and 7. Results: Patients in control group had mean LOS 13.8 days (SD=5.06) compared with 8.1 days (SD=2.47) for intervention group(P=0.004). The mean rank of thirst, hunger and dry mouth scores were significantly higher in the fasted group compared to intervention (15.96 vs 9.04 (P=0.014), 16.46 vs 9.04 (P=0.005) and 17.5 vs 7.5(P=0.000) respectively). REE was significantly higher in the fasted compared to intervention group at postoperative day 1 by mean of 332kcal (P=0.018). Comparing with baseline this rise was significant in the fasting group(P=0.015) but not for intervention group. No difference for trends in MGS and MUAC, morbidity and mortality. Conclusion: Preoperative oral carbohydrate significantly reduced LOS, improved preoperative patient comfort and reduced metabolic response to surgery when compared with conventional fasting from midnight in patients undergoing major hepatobiliary operations.