Oral nutrition or water loading before hip replacement surgery; a randomized clinical trial

Abstract

Background: Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively. The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component (approximately 1 L) rather than to the nutrients.

Methods: Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial, and randomly allocated to preoperative fasting, to oral ingestion of tap water, or to oral ingestion of a carbohydrate drink. An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery, in the postoperative ward, and on the day after surgery. Other parameters were stress (cortisol in plasma and urine), muscle catabolism (urinary 3-methylhistidine), and wellbeing.

Results: Fifty-seven patients completed the study. In the postoperative ward, the glucose clearance and the insulin response had decreased from the previous day by 23% and 36%, respectively. Insulin sensitivity did not decrease until the next morning (-48%) and was due to an increased insulin response (+51%). Cortisol excretion was highest on the day of surgery, while 3-methylhistidine increased 1 day later. Follow-up on the third postoperative day showed an average of 1.5 complications per patient. Wellbeing was better 2 weeks after than before the surgery. None of the measured parameters differed significantly between the study groups.

Conclusions: Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance, insulin sensitivity, postoperative complications, or wellbeing in patients undergoing elective hip surgery.

Trial registration: ClinicalTrials.gov NCT01211184.

Figure 1

Flow chart showing the measurements taken in relation to the surgery.

Figure 2

CONSORT diagram for the trial.

Figure 3

The plasma glucose concentrations during the intravenous glucose tolerance tests (IVGTT). Data are from Day 0 (top row), Day 1 (middle row), and Day 2 (bottom row) in the Fasting, Water, and Nutrition groups, respectively. Each thin line is one IVGTT test. The thick lines are the modeled curves based on the mean values for V_d and CL per each group and occasion.

Figure 4

The plasma insulin concentrations (median) during the IVGTT. Data are from Day 0, Day 1, and Day 2 in the Fasting, Water, and Nutrition groups, respectively.

Figure 5

Wellbeing and life quality shortly after elective total hip replacement surgery. Bars = median values; Error bars = 25^th and 75^th percentiles.