The effect of pre-operative carbohydrate loading in femur fracture: a randomized controlled trial

Narendra Kumar Chaudhary, Dev Ram Sunuwar, Rachit Sharma, Mandeep Karki, Mukti Nath Timilsena, Anita Gurung, Sunil Badgami, Devendra Raj Singh, Prabesh Karki, Kailash Kumar Bhandari, Pranil Man Singh Pradhan, Narendra Kumar Chaudhary, Dev Ram Sunuwar, Rachit Sharma, Mandeep Karki, Mukti Nath Timilsena, Anita Gurung, Sunil Badgami, Devendra Raj Singh, Prabesh Karki, Kailash Kumar Bhandari, Pranil Man Singh Pradhan

Abstract

Background: Femur fracture is a major burden among elderly people, leading patients to be bedridden for a long time in the hospital. The body is more likely to be in a catabolic state as a result of the prolonged fasting period required for surgery, leading to an increase in insulin resistance. Pre-operative carbohydrate loading has been shown to improve postoperative outcomes in several countries. The study aimed to evaluate the effect of pre-operative carbohydrate loading in femur fracture surgery.

Methods: This study was single-center, hospital-based, open-label, parallel-group randomized controlled trial conducted between August 2020 and November 2021. A total of 66 participants, aged 50 years and above having femur fractures planned for surgery were included in this study and assigned to the control (n = 33) and study (n = 33) groups through computer-generated random numbers. The control group was kept fasting from midnight to the next morning as in existence while the study group was intervened with carbohydrate loading according to the Enhanced Recovery After Surgery (ERAS) protocol. The pre-operative nutritional status was identified and the postoperative outcomes were measured using the Visual Analogue Score (VAS), Cumulative Ambulatory Score (CAS), and Modified Barthel Index (MBI) scoring systems. Statistical analyses were performed using the Chi-square test and the Student's two-sample t-test to compare the outcomes between the two groups.

Results: All the participants completed the study. There was a significant reduction in the average postoperative pain in the carbohydrate loading group (VAS: 4.8 (SD ± 1.8), 95% CI: 4.7-5.4) as compared to the control group (VAS: 6.1 (SD ± 2.1), 95% CI: 5.3-6.8). The average CAS showed a significant improvement in regaining the mobility function of participants in the study group (CAS: 8.1 (SD ± 2.8), 95% CI: 7.1-9.1) than that of the control group (CAS: 6.8 (SD ± 2.8), 95% CI: 5.8-7.8). The mean MBI score of the participants at the time of discharge from the hospital was higher in the study group (MBI:13.1 (SD ± 2.3), 95% CI: 12.2-13.9) compared to the control group (MBI: 11.8 (SD ± 3.1), 95% CI:10.6-12.9). Similarly, the length of hospital stay after surgery had decreased in the study group than in the control group.

Conclusions: The uptake of carbohydrate loading showed reduced post-operative pain, enhanced functional mobility, and decreased length of hospital stay. This study warrants larger trials to show the effect of pre-operative carbohydrate loading in a clinical setting.

Trial registration: NCT04838366, first registered on 09/042021 ( https://ichgcp.net/clinical-trials-registry/NCT04838366 ).

Keywords: Femur fracture; Nepal; Pre-operative carbohydrate loading; Surgery.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of the study
Fig. 2
Fig. 2
Box plot graph of VAS, CAS, and MBI scores between control and study group

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