Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery.
BACKGROUND
Major surgery is associated with postoperative insulin resistance which is attenuated by preoperative carbohydrate (CHO) treatment. The effect of this treatment on clinical outcome after major abdominal surgery has not been assessed in a double-blind randomized trial.


METHODS
Patients undergoing elective colorectal surgery or liver resection were randomized to oral CHO or placebo drinks to be taken on the evening before surgery and 2 h before induction of anaesthesia. Primary outcomes were postoperative length of hospital stay and fatigue measured by visual analogue scale.


RESULTS
Sixty-nine and 73 patients were evaluated in the CHO and placebo groups respectively. The groups were well matched with respect to surgical procedure, epidural analgesia, laparoscopic procedures, fasting period before induction and duration of surgery. Postoperative changes in fatigue score from baseline did not differ between the groups. Median (range) hospital stay was 7 (2-35) days in the CHO group and 8 (2-92) days in the placebo group (P = 0.344). For patients not receiving epidural blockade or laparoscopic surgery (20 CHO, 19 placebo), values were 7 (3-11) and 9 (2-48) days respectively (P = 0.054).


CONCLUSIONS
Preoperative CHO treatment did not improve postoperative fatigue or length of hospital stay after major abdominal surgery. A benefit is not ruled out when epidural blockade or laparoscopic procedures are not used.


BACKGROUND
ACTRN012605000456651 (http://www.anzctr.org.au).
Mathur
S
S
Department of Surgery, University of Auckland, Auckland, New Zealand.
Plank
L D
LD
McCall
J L
JL
Shapkov
P
P
McIlroy
K
K
Gillanders
L K
LK
Merrie
A E H
AE
Torrie
J J
JJ
Pugh
F
F
Koea
J B
JB
Bissett
I P
IP
Parry
B R
BR
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002241:Carbohydrates / Q000008:administration & dosage*; D003108:Colonic Diseases / Q000378:metabolism / Q000601:surgery*; D004311:Double-Blind Method; D005221:Fatigue / Q000209:etiology; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D010535:Laparoscopy; D007902:Length of Stay; D008107:Liver Diseases / Q000378:metabolism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology; D011183:Postoperative Complications / Q000378:metabolism / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D012002:Rectal Diseases / Q000378:metabolism / Q000601:surgery*; D016896:Treatment Outcome
D001786:Blood Glucose; D002241:Carbohydrates; D007328:Insulin; D002097:C-Reactive Protein; D006854:Hydrocortisone