RANDOMIZED TRIAL OF PREOPERATIVE CARBOHYDRATE LOADING REDUCING INSULIN RESISTANCE AND COMPLICATIONS IN ELECTIVE COLORECTAL SURGERY

Abstract

Background: Prolonged preoperative fasting has been associated with increased metabolic stress and reduced postoperative recovery in major abdominal surgery. Carbohydrate loading has emerged as a potential strategy to improve insulin sensitivity and enhance postoperative outcomes. Elective colorectal surgery presents a high metabolic burden, making it a suitable field to examine the benefits of preoperative carbohydrate intake.

Objective: To evaluate the effect of preoperative carbohydrate drinks compared with standard fasting on postoperative insulin resistance, complication rates, and hospital stay among patients undergoing elective colorectal surgery.

Methods: This randomized controlled trial included 120 adults scheduled for elective colorectal surgery. Participants were allocated equally into a carbohydrate-loading group and a standard fasting group. The intervention group received a standardized carbohydrate drink the evening before surgery and two hours before anesthesia. Postoperative insulin resistance was measured using the HOMA-IR index within 24 hours. Complications were recorded throughout hospitalization, and length of stay was measured from surgery to discharge. Data were analyzed using t-tests for continuous variables and chi-square tests for categorical variables.

Results: The carbohydrate-loading group demonstrated lower postoperative insulin resistance (mean HOMA-IR 2.1 ± 0.5) than the control group (3.0 ± 0.6). Complications were recorded in 18.3% of participants receiving carbohydrate drinks and 35.0% of those in the standard fasting group. Mean hospital stay was shorter in the carbohydrate group (5.4 ± 1.2 days) compared with controls (7.1 ± 1.5 days). All primary and secondary outcomes showed consistently favorable trends in the intervention group.

Conclusion: Preoperative carbohydrate loading improved metabolic response and postoperative outcomes in elective colorectal surgery. Its simplicity, affordability, and clinical effectiveness support incorporation into perioperative care pathways.