Perioperative Carbohydrate Loading and Enhanced Recovery: Where the Nutritional Component Actually Contributes
DOI:
https://doi.org/10.5281/zenodo.22281707Keywords:
Carbohydrate loading, Enhanced recovery after surgery, Insulin resistance, Preoperative fasting, Evidence qualityAbstract
Enhanced recovery programmes reduce length of stay by up to 30 per cent and complications by as much as 50, and preoperative
carbohydrate loading is one of their numerous components. Attributing the programme effect to the drink is the error this review
examines. Guidelines recommend loading strongly while stating that the quality of underlying evidence remains low or moderate.
A Bayesian network meta-analysis found low-dose oral carbohydrate associated with reduced postoperative infection at 0.42
(95% CrI 0.20 to 0.81), and no significant difference from control in the other outcomes examined, concluding that there is no
evidence the drink alleviates patient discomfort. A review of six randomised trials found loading consistently safe, with no delayed
gastric emptying or aspiration, while effects on length of stay and complications remained variable. Safety is the most
reproducible finding.
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