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Impact Of Carbohydrate Protocols In Early Surgical Recovery Protocols
*Jesse Sulzer, *Garth Davis, *Roy Nanz, *Anthony Spensieri, *Colin Bird, Joseph F Buell
Mission Hospital and HCA Healthcare, Asheville, NC

Objective: Preoperative carbohydrate loading is an integral part of Early Surgical Recovery (ESR). Perioperative carbohydrate loading has been demonstrated to minimize insulin resistance. Multiple protocols exist for carbohydrate loading but few studies have examined the impact of doses given or optimal timing for supplements. This study analyzes the differences of a single or multiple preoperative supplements. Methods: Over the last year our institution has initiated a system wide ESR program across abdominal surgery (Bariatric, General and GYN surgery) and orthopedic service lines. Demographics and perioperative outcomes were analyzed for our first 2040 ESR patients.
Results: Two hundred and ninety (14.3%) of ESR group patients received only a single carbohydrate drink the night before surgery. The remainder of patients received two or three of the same carbohydrate drinks. The single drink group had a higher incidence of diabetics and abdominal procedures at baseline. However, the multi drink group had a lower pain score, blood sugars, use of insulin drips, length of stays and 30-day rate of readmission.

CarbAgeAbdominalProceduresDiabeticPain ScoreOpioids GivenA1CInsulin DripsLOS30-day ReadmitInitial BSLast BS
Single (n=291)61.645.9%75.2%
Multiple(n= 1749)61.539.7%7.7%
P value0.9600.047<0.0010.0180.016<0.000<0.0010.0130.082<0.001<0.001

Regression analysis for readmission identified the use of insulin drips (2.92; p=0.003) and the single carbohydrate supplement protocol (-2.80: p=0.037) as significant factors.
Conclusions: The use of carbohydrate loading remains critical in early surgical recovery protocols. This study is the first to identify the number and sequence of carbohydrate loading may significantly impact blood sugars, patientís catabolic state and clinical outcomes such as insulin drip requirements, increased level of care and 30-day readmissions.

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