The effects of preoperative carbohydrate loading on the metabolic response to surgery in a low resource setting

Abstract

BackgroundThe stress response to surgery involves catabolism and gluconeogenesis resulting in postoperative hyperglycaemia. Postoperative hyperglycaemia is a risk factor for postoperative complications and preoperative fasting further aggravates this response. A carbohydrate (CHO) drink instead of fasting is expected to decrease insulin resistance and reduce post-operative hyperglycaemia. The aim of this study was to assess the effect of the reduction of the pre-operative fasting period on post-operative hyperglycaemia and post-operative complications in open surgery. MethodsA hospital-based prospective case control study of 70 patients scheduled for elective surgery were sampled to either a case (carbohydrate-loaded) or a control (FAST) group. Postoperative hyperglycaemia and complications were the primary and secondary outcomes respectively reported. Results70 patients were recruited with 35 patients per group. 40 (57%) were females. The mean blood glucose on the first postoperative day was significantly higher in those who fasted (146.20 ± 38.36 mg/dl) than in those who received the energy drink (123.06 ± 26.64 mg/dl), p = 0.004. Postoperative infections were significantly higher in the control group than in the CHO group (31.43%; and 8.57%; 95% C.I: 1.23–19.47) p = 0.033. The mean length of hospital stay was longer in the FAST (12.54days ± 15.08) than in the CHO (9.17days ± 12.65) group although the difference was not statistically significant p = 0.315. The mean age, surgery type and mean duration of surgery were significant between groups but not upon logistic regression for significant clinical and demographic variables. ConclusionPreoperative CHO loading is effective and safe in reducing post-operative hyperglycaemia and infection in open general surgery even in a low resource setting.