General thoracic and cardiovascular surgery · 2025
Influence of preoperative oral carbohydrate loading on the outcome of esophageal cancer surgery: an interrupted time series analysis of the transition from fasting with intravenous infusion to oral intake protocol.
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Takahashi Naoki, Okamura Akihiko, Miyazaki Naoki, Kuriyama Kengo, Terayama Masayoshi, Tamura Masahiro, Ishida Hiroki, Kanamori Jun, Taketomi Akinobu, Watanabe Masayuki
Аннотация
OBJECTIVE: Prolonged preoperative fasting has been reported to increase patient discomfort, induce insulin resistance, and lead to complications and delayed recovery. We introduced preoperative oral carbohydrate (CHO) loading, and this study aimed to evaluate the influence on the outcomes of esophageal cancer surgery.
METHODS: We evaluated 270 patients who underwent minimally invasive esophagectomy for esophageal cancer. Before implementation, patients fasted after the evening meal on the day before surgery and received glucose-electrolyte infusion. After implementation, patients received oral CHO loading up to three hours before surgery instead of infusion. We evaluated its impact on the incidence of perioperative complications, time to first defecation, length of hospital stay, and postoperative glycemic changes using interrupted time series analysis.
RESULTS: There were 136 and 134 patients before and after implementation, respectively. No patient experienced aspiration during anesthesia induction. No significant changes were observed in the incidence of postoperative complications (coefficient 6.51, 95% confidence interval - 20.6 to 33.6) or length of stay (coefficient 1.34, 95% confidence interval - 4.75 to 7.42) after the implementation. Meanwhile, a significant reduction in time to first defecation was observed after implementation (coefficient - 0.73, 95% confidence interval - 1.42 to - 0.05). No significant differences in postoperative blood glucose levels were noted.
CONCLUSIONS: Preoperative oral CHO loading for esophageal cancer surgery can be safely implemented without increasing postoperative complications, blood glucose levels, or length of hospital stay, and is associated with reduction in time to first defecation.
METHODS: We evaluated 270 patients who underwent minimally invasive esophagectomy for esophageal cancer. Before implementation, patients fasted after the evening meal on the day before surgery and received glucose-electrolyte infusion. After implementation, patients received oral CHO loading up to three hours before surgery instead of infusion. We evaluated its impact on the incidence of perioperative complications, time to first defecation, length of hospital stay, and postoperative glycemic changes using interrupted time series analysis.
RESULTS: There were 136 and 134 patients before and after implementation, respectively. No patient experienced aspiration during anesthesia induction. No significant changes were observed in the incidence of postoperative complications (coefficient 6.51, 95% confidence interval - 20.6 to 33.6) or length of stay (coefficient 1.34, 95% confidence interval - 4.75 to 7.42) after the implementation. Meanwhile, a significant reduction in time to first defecation was observed after implementation (coefficient - 0.73, 95% confidence interval - 1.42 to - 0.05). No significant differences in postoperative blood glucose levels were noted.
CONCLUSIONS: Preoperative oral CHO loading for esophageal cancer surgery can be safely implemented without increasing postoperative complications, blood glucose levels, or length of hospital stay, and is associated with reduction in time to first defecation.