Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture: a pilot study

Abstract

Background: Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture.

Methods: In a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77-97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45-71 and ten healthy volunteers, age 28-55.

Results: The mean gastric half-emptying time in the elderly study group was 53 ± 5 (39-82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 ± 4 (41-106) and 59 ± 5 (33-72) minutes, indicating normal gastric emptying time in elderly with hip fracture.

Conclusion: This pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.

Trial registration: ClinicalTrials.gov NCT02753010 . Registered 17 April 2016, retrospectively.

Keywords: Aspiration; Carbohydrate loading; Metabolism; Nutrition; Surgery.

Fig. 1

Boxplots of gastric half-emptying time using the paracetamol absorption technique in three groups of women: Elderly women with acute hip fracture (n = 9), women with osteoarthritis scheduled for elective hip replacement (n = 10) and healthy female volunteers

Fig. 2

Individual gastric emptying profiles of nine elderly women with acute hip fracture. In all patients the gastric emptying curve fulfilled requirements of a third-order polynomial sigmoid curve by which gastric lag phase, half-emptying times and complete emptying were calculated (see Table 1)