Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 May 6;24(1):401.
doi: 10.1186/s12877-024-04958-7.

A feasibility study on preoperative carbohydrate loading in older patients undergoing hip fracture surgery

Kai Sing Yap  1 , P S Loh  2 , Yi Xian Foong  1 , Chu Zhen Mok  3 , Terence Ong  4 , Hui Min Khor  4
Affiliations
Randomized Controlled Trial

A feasibility study on preoperative carbohydrate loading in older patients undergoing hip fracture surgery

Kai Sing Yap et al. BMC Geriatr. .

Abstract

Background: Preoperative carbohydrate loading in Enhanced Recovery After Surgery is an independent predictor of postoperative outcomes. By reducing the impact of surgical stress response, fasting-induced insulin resistance is modulated. As a clear fluid, consuming carbohydrate drink is safe up to 2 h preoperatively. Widely practiced in abdominal surgeries, its implementation in hip fracture surgeries is yet to be recognized. This study aimed to identify the feasibility of preoperative carbohydrate loading in hip fracture surgery and assess its clinical effects.

Methods: This was a randomized controlled, open labelled trial. Patients ≥ 65 years old without diabetes mellitus, has hip fracture were recruited in a tertiary hospital between November 2020 and May 2021. The intervention was carbohydrate loading versus standard preoperative fasting.

Results: Thirty-four ASA I-III patients (carbohydrate loading and control, n = 17 each), mean age 78 years (SEM ± 1.5), mean body mass index 23.7 (SEM ± 0.6 kg/m2) were recruited. Analysis for feasibility of carbohydrate loading (n = 17) demonstrated attrition rate of 29% (n = 5). Otherwise, all recruited patients were compliant (100% compliance) with no adverse events reported. There was no significant difference among groups in the postoperative nausea and vomiting, pain score, fatigue level, muscle strength, postoperative infection and length of hospital stay assessed at 24-48 h postoperatively.

Conclusion: The implementation of preoperative carbohydrate loading was found to be feasible preoperatively in hip fracture surgeries but requires careful coordination among multidisciplinary teams. An adequately powered randomized controlled study is needed to examine the full benefits of preoperative carbohydrate loading in this group of patients.

Trial registration: This study was registered in ClinicalTrial.gov (ClinicalTrials.gov identifier: NCT04614181, date of registration: 03/11/2020).

Keywords: Carbohydrate loading; Elderly; Hip fracture.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT (Consolidated Standards of Reporting Trials) Flow Diagram
See this image and copyright information in PMC

References

    1. Cheung CL, Ang SB, Chadha M, Chow ES, Chung YS, Hew FL, Jaisamrarn U, Ng H, Takeuchi Y, Wu CH, et al. An updated hip fracture projection in Asia: the Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia. 2018;4(1):16–21. doi: 10.1016/j.afos.2018.03.003. - DOI - PMC - PubMed
    1. ANZHFR Bi-National Annual Report for Hip Fracture Care. 2017 [https://anzhfr.org/wp-content/uploads/sites/1164/2021/12/ANZHFR-Annual-R...].
    1. Bell J, Bauer J, Capra S, Pulle CR. Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine? Can J Physiol Pharmacol. 2013;91(6):489–95. doi: 10.1139/cjpp-2012-0301. - DOI - PubMed
    1. Fawcett J, Ljungqvist W. Starvation, carbohydrate loading, and outcome after major surgery. BJA Educ. 2017;17(9):312–6. doi: 10.1093/bjaed/mkx015. - DOI
    1. Garcia AE, Bonnaig JV, Yoneda ZT, Richards JE, Ehrenfeld JM, Obremskey WT, Jahangir AA, Sethi MK. Patient variables which may predict length of stay and hospital costs in elderly patients with hip fracture. J Orthop Trauma. 2012;26(11):620–3. doi: 10.1097/BOT.0b013e3182695416. - DOI - PubMed

Publication types

Associated data