Publication:

Evaluation of preoperative carbohydrate loading compared to preoperative fasting for enhanced recovery after elective gynecological surgeries

Background This study aimed to evaluate the impact of preoperative carbohydrate loading on insulin resistance and clinical outcomes in patients undergoing elective gynecological surgeries.

Methods A single-center, parallel-group, randomized controlled study was conducted at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. Thirty-nine patients were randomized into two groups: the carbohydrate loading group (CHO, n=20) received 600 ml of a carbohydrate-rich drink the day before surgery and 200 ml two hours before surgery; the control group (CO, n=19) fasted overnight.

Results Baseline serum insulin, blood glucose, and insulin resistance levels were similar between the groups. Two hours before surgery, the CO group had significantly higher serum insulin levels (7.5±5.6 IU/ml) compared to the CHO group (4.5±2.9 IU/ml) (t=2.08, p=0.04). Insulin resistance was also higher in the CO group (1.9±1.6) compared to the CHO group (0.9±0.6) (t=2.40, p=0.02). Seventy-five percent of the CHO group regained bowel sounds within 24 hours post-surgery, compared to seventy-three percent of the CO group, who achieved bowel sounds after 24 hours (χ²=9.24, p=0.02). No significant differences were observed in postoperative mobilization, urinary catheter removal, fever, nausea, vomiting, length of hospital stay, or surgical site infections.

Conclusions Preoperative carbohydrate loading reduces insulin resistance and facilitates faster bowel recovery without increasing postoperative complications in elective gynecological surgery.