Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: A scoping review

Table 3 Preoperative carbohydrate load: Impact on glycemic variability and surgical outcomes

Ref.	Patient population	PCL composition and timing	Reported conclusion
Singh et al[22], 2015	120 same-day surgery patients, DM excluded	12.5% CHO, 500 kcal/L; 400 mL before MN + 200 mL 2 h before surgery	Intervention vs placebo vs control
			Nausea score
			0-4 h: 0.65 vs 1.30 vs 1.23, P = 0.001
			4-12 h: 0.70 vs 0.83 vs 1.05, P = 0.066
			12-24 h: 0.25 vs 0.43 vs 0.35, P = 0.257
			Vomit incidence
			0-4 h: 17.5% vs 42.5% vs 47.5%, P (I-P) ≤ 0.001, P (I-C) = 0.004
			4-12 h: 7.5% vs 12.5% vs 32.5%, P (I-P) = 0.459, P (I-C) = 0.005
			12-24 h: 0% vs 2.5% vs 2.5%, P (I-P) = 0.314, P (I-C) = 0.314
			Pain score
			0-4 h: 5.75 vs 7.13 vs 6.95, P = 0.001
			4-12 h: 3.53 vs 4.08 vs 4.65, P = 0.005
			12-24 h: 1.95 vs 2.08 vs 2.25, P = 0.223
Gianotti et al[23], 2018	662 patients undergoing elective major abdominal surgery, DM excluded	12.6% CHO, 500 kcal/L; 800 mL between 8 pm and 2 h before surgery	Intervention vs placebo
			Composite infection: 16.3% vs 16.0%, P = 1.00
			Insulin requirement: 2.4% vs 16%, P < 0.001
			Antibiotic therapy: 30.8% vs 29.9%, P = 0.87
			Total complications: 28.1% vs 28.4%, P = 1.00
			Hospital LOS: 11 vs 11 d, P = 0.44
			Aspiration events: 0 vs 0, P = 1.00
Liu et al[24], 2019	120 patients undergoing elective craniotomy, DM excluded	12.5% CHO, 500 kcal/L; 400 mL 2 h before surgery	Intervention vs control
			Preop BGC: 6.3 vs 5.6 mmol/L, P = 0.020
			POD3 BGC: 5.6 vs 6.3 mmol/L, P = 0.001
			POD3 handgrip: 25.3 vs 19.9 kg, P < 0.0001
			POD3 PEFR: 315.8 vs 270.0 L/min, P = 0.036
			Postop LOS: 4 vs 7 d, P < 0.0001
Talutis et al[25], 2020	169 patients with DM2 undergoing elective major abdominal surgery	55 g CHO in 32 oz (946.35 mL), 5.8% CHO; 16 oz (473 mL) before MN + 16 oz 2 h before surgery	Intervention vs control
			Preop BGC: 142 vs 129.5 mg/dL, P = 0.017
			1st postop BGC: 159 vs 173 mg/dL, P = 0.23
			POD1 BGC: 152 vs 137.5 mg/dL, P = 0.004
			Intraop insulin: 0-16 vs 0-19 units, P = 0.63
			POD1 insulin: 0-75 vs 0-79 units, P = 0.09
			Complication rate: 20% vs 27%, P = 0.65
			Hospital LOS: 2 vs 2 d, P = 0.38
			Aspiration events: 0 vs 0, P = 1.00
Suh et al[26], 2021	134 patients undergoing bariatric surgery, DM2 included	50 g CHO in 296 mL, 16.9% CHO, 682 kcal/L; 296 mL before MN + 296 mL 3 h before surgery	Intervention vs control
			Hospital LOS: 2.0 vs 2.1 d, P = 0.65
			PONV score: 13.8 vs 15.4, P = 0.77
			BGC: 140.7 vs 135.3 mg/dL, P = 0.34
			Antiemetics: 5.3 vs 6 doses, P = 0.43
			Readmission: 4.7% vs 5.7%, P = 0.79
			Complication: 3.1% vs 4.3%, P = 0.72
			Aspiration events: 0 vs 0, P = 1.00
Lee et al[27], 2022	46 patients with DM2 undergoing elective total joint arthroplasty	12.8% CHO, 500 kcal/mL; 400 mL 2-3 h before anesthesia	Intervention vs control
			CV: 16.5% vs 10.1%, P = 0.008
			J index: 25.3 vs 18.9, P = 0.046
			HOMA-IR: 8.5 vs 2.7, P < 0.001
			Hospital LOS: 3 vs 3 d, P = 0.516
			Nausea: 46% vs 29%, P = 0.402
			Vomiting: 32% vs 8%, P = 0.066
			Hypotension: 5% vs 13%, P = 0.609
			Delirium: 18% vs 0%, P = 0.045
			Wound dehiscence: 9% vs 8%, P = 0.999
			Pain score at 6 h: 2 vs 2, P = 0.725

PCL: Preoperative carbohydrate load; DM: Diabetes mellitus; CHO: Carbohydrate; MN: Midnight; LOS: Length of stay; BGC: Blood glucose concentration; Preop: Preoperative; POD: Postoperative day; PEFR: Peak expiratory flow rate; postop: Postoperative; DM2: Type 2 diabetes mellitus; ERAS: Enhanced recovery after surgery; intraop: Intraoperative; PONV: Postoperative nausea and vomiting; CV: Coefficient of variance; HOMA-IR: Homeostasis Model Assessment Insulin Resistance.