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Perioperative glycemic measures among non-fasting gynecologic oncology patients receiving carbohydrate loading in an enhanced recovery after surgery (ERAS) protocol
  1. Stephanie Alimena1,2,
  2. Michele Falzone1,
  3. Colleen M Feltmate3,4,
  4. Kia Prescott3,
  5. Leah Contrino Slattery4 and
  6. Kevin Elias3,4
  1. 1 Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2 Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3 Dana Farber Cancer Institute, Boston, Massachusetts, USA
  4. 4 Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Stephanie Alimena, Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA; salimena{at}partners.org

Abstract

Introduction Preoperative carbohydrate loading is an effective method to control postoperative insulin resistance. However, data are limited concerning the effects of carbohydrate loading on preoperative hyperglycemia and possible impacts on complication rates.

Methods A prospective cohort study was performed of patients enrolled in an enhanced recovery after surgery pathway at a single institution. All patients underwent laparotomy for known or suspected gynecologic malignancies. Patients who had been diagnosed with diabetes preoperatively and those prescribed total parenteral nutrition by their providers were excluded. Data regarding preoperative carbohydrate loading with a commercial maltodextrin beverage, preoperative glucose testing, postoperative day 1 glucose, insulin administration, and complications (all complications, infectious complications, and hyperglycemia-related complications) were collected. The primary endpoint of the study was the incidence of postoperative infectious complications, defined as superficial or deep wound infection, organ/space infection, urinary tract infection, pneumonia, sepsis, or septic shock.

Results Of 415 patients, 76.9% had a preoperative glucose recorded. The mean age was 60.5±12.4 years (range 18–93). Of those with recorded glucose values, 30 patients (9.4%) had glucose ≥180 mg/dL, none of whom were actually given insulin preoperatively. Median preoperative glucose value was significantly increased after carbohydrate loading (122.0 mg/dL with carbohydrate loading vs 101.0 mg/dL without, U=3143, p=0.001); however, there was no relationship between carbohydrate loading and complications. There was a significantly increased risk of hyperglycemia-related complications with postoperative day 1 morning glucose values ≥140 mg/dL (OR 1.85, 95% CI 1.07 to 3.23; p=0.03). Otherwise, preoperative and postoperative hyperglycemia with glucose thresholds of ≥140 mg/dL or ≥180 mg/dL were not associated with increased risk of other types of complications.

Discussion Carbohydrate loading is associated with increased preoperative glucose values; however, this is not likely to be clinically significant as it does not have an impact on complication rates. Preoperative hyperglycemia is not a risk factor for postoperative complications in a carbohydrate-loaded population when known diabetic patients are excluded.

Precis While glucose increased with carbohydrate loading in non-diabetic patients, this was not associated with complications.

  • preoperative glucose
  • carbohydrate loading
  • postoperative complications
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Footnotes

  • Contributors All authors contributed substantially to the research work, including manuscript preparation, and have agreed with the final product submitted here. SA, MD: performed conceptualization, investigation, methodology, formal analysis, and manuscript preparation. MA: performed data acquisition and preliminary analysis, and assisted with manuscript preparation. CF, MD; performed conceptualization, data interpretation, and manuscript preparation. KP, PA-C: performed conceptualization, data interpretation, and manuscript preparation. LCS, PA-C: performed conceptualization, data interpretation, and manuscript preparation. KE, MD: performed conceptualization, investigation, methodology, formal analysis, and manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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