PhilSPEN Online Journal of Parenteral and Enteral Nutrition

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(Article 77 | POJ_0071)

Submitted Abstracts

PENSA 2017 Congress

Submitted: August 11, 2017

Abstract ID = 41 | Classification: (10) - Others

Title: The ‘SUN’ Initiative: Does Preoperative Carbohydrate Treatment Help Outcomes of Surgery?

Author(s): Radha R C (1)., Gurava Reddy A V (2)., Anita M (3)

  1. PhD, Chief Consultant Clinical Dietician & HOD, Department of Dietetics, Sunshine Hospitals, Paradise, Secunderabad, Telangana, India.
  2. Managing Director and Chief Joint Replacement Surgeon, Sunshine Hospitals.
  3. Department of Dietetics, Sunshine Hospitals.

Institution where study was conducted: Sunshine Hospitals

Keywords: carbohydrate loading, insulin resistance, PINI, VAS scores, hunger, thirst, fasting

Background: Peri-operative surgical care is undergoing a paradigm shift with new protocols formulated in ERAS pathways. Preoperative treatment with carbohydrate drinks is one such strategy to improve the clinical status of patients.

Objectives: This study examines the surgical outcome with preoperative carbohydrate loading and determines the scope to scale up nutrition and improve patient outcomes.

Methods: The study evaluated 140 blinded, randomized patients of both sexes, undergoing orthopedic surgery. Two groups of patients: control group (CO)(n=69; 8–12hr fasting) and the intervention group (CHO)(n=71; 6-8hr fasted to solids and given a beverage containing 12.5% carbohydrate). Blood samples were collected before surgery and 24hours afterwards for biochemical assays. The endpoints of the study were the insulin resistance (IR), the prognostic inflammatory and nutritional index (PINI) and visual analogue scale (VAS) scores for thirst and hunger.

Results: 99 females and 41 males aged between of 33-80 years were studied. There were no anesthetic or postoperative complications. Post-operative IR was lower in the CHO group as compared to CO group (10.77±1.11 vs 11.22 ±1.43), but not statistically significant. There was no significant difference between the two groups in relation to the postoperative PINI. The VAS scores for thirst during pre surgery (4.67±0.156 vs 2.66±0.87) and post surgery (6.45±0.097 vs 2.63±0.086) was higher in CO group as compared to CHO group and was statistically significant (p=0.000). Similar trend was observed for VAS scores for hunger post surgery (5.55±0.119 vs 3.07±0.143) (p=0.000).

Conclusion: Shortening the pre-operative fasting using carbohydrate reduces insulin resistance and post-operative acute phase response and improves overall wellbeing in elective surgeries.