Longterm effects of preoperative carbohydrate loading for colorectal surgery

Abstract

Recent changes in preoperative fasting guidelines have resulted in the development of preoperative carbohydrate drinks. Almost all research to date has examined the immediate/early postoperative metabolic and physiological effects, concluding beneficial clinical outcomes post surgery. The aim of this study was to test the hypothesis that preoperative carbohydrate loading results in longer term improvements in wellbeing, sustained return of postoperative physical function and better retention of muscle mass and nutritional status at a later (and potentially more clinically relevant) stage in the postoperative recovery period. This double-blinded placebo controlled randomised control trial took place at Salford Royal NHS Foundation Trust between 1st April 2008 and 31st January 2010. 10 males and 4 females, with a median age of 65.5 years, were included in the study and these were all listed for potentially curative colorectal cancer surgery. Each participant was assessed preoperatively, daily throughout their hospital admission and then at 30 days post surgery. Assessments included anthropometric measurements, analysis of dietary intake, physical activity and an evaluation of pain and well-being. The results showed that carbohydrate loading had no significant effects on anthropometric, dietary, physical or well-being parameters. However it was seen that pain scores in those patients who received carbohydrate loading were significantly lower (p=0.017) 30 days post surgery than those who received the placebo drinks. The trial was a pilot study and has shown that further research is needed to determine whether carbohydrate loading may have long-term clinical benefits.