Efficacy of preoperative administration of oral carbohydrates in patients undergoing elective hip replacement surgery: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Li ¹ , SHUAI Ting ² , WANG Yunyun ¹ ,  CAO Hong ³

1. Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China;
2. School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China;
3. Department of Osteoporosis Internal Medicine, Tianjin Hospital, Tianjin, 300211, P.R.China;

Corresponding author：

CAO Hong, Email: caohong1968@yeah.net

Keywords：

Carbohydrate; Oral; Hip arthroplasty; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201702069

Video：

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Objective To systematically review the efficacy of preoperative administration of oral carbohydrates in patients undergoing elective hip replacement surgery. Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) about preoperative oral carbohydrate treatment in patients undergoing elective hip arthroplasty from inception to January, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 10 RCTs were included. The results of meta-analysis showed that: compared with the placebo group, the preoperative oral carbohydrate group had no significant differences in postoperative insulin resistance (SMD=5.14, 95%CI –1.05 to 11.33, P=0.10), length of hospital stay (MD=–0.26, 95%CI –1.11 to 0.58, P=0.54), rate of complications (OR=1.46, 95%CI 0.53 to 4.07, P=0.47), postoperative glucose and insulin level. Conclusion Current evidence shows that preoperative oral carbohydrate can not mediate postoperative insulin resistance. It also does not reduce length of hospital stay, postoperative glucose and insulin level. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

Citation： WANG Li, SHUAI Ting, WANG Yunyun, CAO Hong. Efficacy of preoperative administration of oral carbohydrates in patients undergoing elective hip replacement surgery: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(10): 1205-1211. doi: 10.7507/1672-2531.201702069 Copy

1.	Ashby E, Grocott MPW, Haddad FS. Outcome measures for orthopaedic interventions on the hip. J Bone Joint Surg, 2008, 90(5): 545-549.
2.	Macaulay W, Pagnotto MR, Iorio R, et al. Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty. J Am Acad Orthop Surg, 2006, 14(5): 287-293.
3.	Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2, 289 patients. Acta Orthop, 2006, 77(3): 359-367.
4.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
5.	Nygren J. The metabolic effects of fasting and surgery. Best Pract Res Clin Anaesthesiol, 2006, 20(3): 429-438.
6.	Awad S, Constantin-Teodosiu D, Macdonald IA, et al. Short-term starvation and mitochondrial dysfunction-a possible mechanism leading to postoperative insulin resistance. Clin Nutr, 2009, 28(5): 497-509.
7.	Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med, 2003, 31(2): 359-366.
8.	Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc, 2004, 79(8): 992-1000.
9.	Ljungqvist O, Thorell A, Gutniak M, et al. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance. J Am Coll Surg, 1994, 178(4): 329-336.
10.	Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr, 1998, 17(2): 65-71.
11.	Ljungqvist O. Modulating postoperative insulin resistance by preoperative carbohydrate loading. Best Pract Res Clin Anaesthesiol, 2009, 23(4): 401-409.
12.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: http://handbook. cochrane.org.
13.	Soop M, Nygren J, Myrenfors P, et al. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am J Physiol Endocrinol Metab, 2001, 280(4): 576-583.
14.	Soop M, Nygren J, Thorell A, et al. Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery. Clin Nutr, 2004, 23(4): 733-741.
15.	Ljunggren S, Hahn RG. Oral nutrition or water loading before hip replacement surgery: a randomized clinical trial. Trials, 2012, 13(1): 1.
16.	Harsten A, Hjartarson H, Toksvig-Larsen S. Total hip arthroplasty and perioperative oral carbohydrate treatment: a randomised, double-blind, controlled trial. Eur J Anaesthesiol, 2012, 29(6): 271-274.
17.	Ljunggren S, Hahn R G, Nyström T. Insulin sensitivity and beta-cell function after carbohydrate oral loading in hip replacement surgery: a double-blind, randomized controlled clinical trial. Clin Nutr, 2014, 33(3): 392-398.
18.	Çeliksular MC, Saraçoğlu A, Yentür E. The influence of oral carbohydrate solution intake on stress response before total hip replacement surgery during epidural and general anaesthesia. Turk J Anaesthesiol Reanim, 2016, 44(3): 117.0.
19.	汪卫, 王勇平. 术前口服碳水化合物对高龄患者髋关节置换术后胰岛素抵抗的影响. 中国医药导报, 2015, 12(4): 63-66.0.
20.	Dock-nascimento D, Aguilar-Nascimento JE, Caporossi C, et al. Safety of oral glutamine in the abbreviation of preoperative fasting; a double-blind, controlled, randomized clinical trial. Nutr Hosp, 2011, 26(1): 86-90.
21.	Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes care, 2004, 27(6): 1487-1495.
22.	Jones C, Badger SA, Hannon R. The role of carbohydrate drinks in preoperative nutrition for elective colorectal surgery. Ann R Coll Surg Engl, 2011, 93(7): 504-507.
23.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
24.	Shanley S. Preoperative carbohydrate loading: a review of the current evidence. J Hum Nutr Diet, 2009, 22(3): 261-262.
25.	Awad S, Varadhan KK, Ljungqvist O, et al. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr, 2013, 32(1): 34-44.
26.	Smith MD, Mccall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev, 2014, (8): CD009161.
27.	Petersen KF, Shulman GI. Etiology of insulin resistance. Am J Med, 2006, 119(5): 10-16.
28.	Muniyappa R, Lee S, Chen H, et al. Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab, 2008, 294(1): 15-26.

1. Ashby E, Grocott MPW, Haddad FS. Outcome measures for orthopaedic interventions on the hip. J Bone Joint Surg, 2008, 90(5): 545-549.
2. Macaulay W, Pagnotto MR, Iorio R, et al. Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty. J Am Acad Orthop Surg, 2006, 14(5): 287-293.
3. Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2, 289 patients. Acta Orthop, 2006, 77(3): 359-367.
4. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
5. Nygren J. The metabolic effects of fasting and surgery. Best Pract Res Clin Anaesthesiol, 2006, 20(3): 429-438.
6. Awad S, Constantin-Teodosiu D, Macdonald IA, et al. Short-term starvation and mitochondrial dysfunction-a possible mechanism leading to postoperative insulin resistance. Clin Nutr, 2009, 28(5): 497-509.
7. Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med, 2003, 31(2): 359-366.
8. Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc, 2004, 79(8): 992-1000.
9. Ljungqvist O, Thorell A, Gutniak M, et al. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance. J Am Coll Surg, 1994, 178(4): 329-336.
10. Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr, 1998, 17(2): 65-71.
11. Ljungqvist O. Modulating postoperative insulin resistance by preoperative carbohydrate loading. Best Pract Res Clin Anaesthesiol, 2009, 23(4): 401-409.
12. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: http://handbook. cochrane.org.
13. Soop M, Nygren J, Myrenfors P, et al. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am J Physiol Endocrinol Metab, 2001, 280(4): 576-583.
14. Soop M, Nygren J, Thorell A, et al. Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery. Clin Nutr, 2004, 23(4): 733-741.
15. Ljunggren S, Hahn RG. Oral nutrition or water loading before hip replacement surgery: a randomized clinical trial. Trials, 2012, 13(1): 1.
16. Harsten A, Hjartarson H, Toksvig-Larsen S. Total hip arthroplasty and perioperative oral carbohydrate treatment: a randomised, double-blind, controlled trial. Eur J Anaesthesiol, 2012, 29(6): 271-274.
17. Ljunggren S, Hahn R G, Nyström T. Insulin sensitivity and beta-cell function after carbohydrate oral loading in hip replacement surgery: a double-blind, randomized controlled clinical trial. Clin Nutr, 2014, 33(3): 392-398.
18. Çeliksular MC, Saraçoğlu A, Yentür E. The influence of oral carbohydrate solution intake on stress response before total hip replacement surgery during epidural and general anaesthesia. Turk J Anaesthesiol Reanim, 2016, 44(3): 117.0.
19. 汪卫, 王勇平. 术前口服碳水化合物对高龄患者髋关节置换术后胰岛素抵抗的影响. 中国医药导报, 2015, 12(4): 63-66.0.
20. Dock-nascimento D, Aguilar-Nascimento JE, Caporossi C, et al. Safety of oral glutamine in the abbreviation of preoperative fasting; a double-blind, controlled, randomized clinical trial. Nutr Hosp, 2011, 26(1): 86-90.
21. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes care, 2004, 27(6): 1487-1495.
22. Jones C, Badger SA, Hannon R. The role of carbohydrate drinks in preoperative nutrition for elective colorectal surgery. Ann R Coll Surg Engl, 2011, 93(7): 504-507.
23. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
24. Shanley S. Preoperative carbohydrate loading: a review of the current evidence. J Hum Nutr Diet, 2009, 22(3): 261-262.
25. Awad S, Varadhan KK, Ljungqvist O, et al. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr, 2013, 32(1): 34-44.
26. Smith MD, Mccall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev, 2014, (8): CD009161.
27. Petersen KF, Shulman GI. Etiology of insulin resistance. Am J Med, 2006, 119(5): 10-16.
28. Muniyappa R, Lee S, Chen H, et al. Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab, 2008, 294(1): 15-26.

Chinese Journal of Evidence-Based Medicine

Efficacy of preoperative administration of oral carbohydrates in patients undergoing elective hip replacement surgery: a meta-analysis

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