Preoperative carbohydrate intake linked to Success of surgery of Osteoporotic fractures in Elderly

In a groundbreaking study conducted at a prominent Chinese institution, researchers have unveiled a promising connection between preoperative oral carbohydrate (CHO) intake and improved outcomes for elderly patients undergoing surgical treatment for osteoporotic fractures (OPFs). The study addressed the notable gap in the utilization of this practice and concluded that preoperative oral CHO intake may correlate with reduced mortality risk and improved outcomes in elderly patients undergoing surgical treatment for OPFs.

The study results were published in the Journal of Orthopedic Surgery and Research.

Despite the well-established benefits of preoperative CHO intake, its underutilization, especially among older patients facing orthopedic surgery for OPFs, has raised eyebrows. This prompted a comprehensive retrospective cohort study, enrolling 879 elderly patients, with a median age of 71 years, to investigate the potential correlation between preoperative oral CHO consumption and surgical outcomes.

The study, conducted at a single Chinese institution, implemented stringent exclusion criteria and utilized propensity score matching to ensure a balanced analysis. The  exclusion criteria were: 

1. The necessity for urgent surgical intervention
2. The existence of hypoglycemia, hyperglycemia, or diabetes mellitus with blood glucose levels lower than 2.8 mmol/L
3. A medical history of gastrointestinal motility disorders or delayed gastric emptying
4. The utilization of local anesthesia
5. A Charlson comorbidity index (CCI) score over 2
6. An American Society of Anesthesiologists (ASA) score exceeding 3.

 After matching, 264 patients in each cohort were subjected to rigorous evaluation, focusing on primary outcomes such as the 60-day all-cause mortality rate, and secondary outcomes, including the length of hospital stay (LOS), hospitalization costs, blood transfusions, and postoperative complications. 

Key Findings:

• Post-propensity score matching, the study yielded compelling results.
• Patients who received preoperative oral CHO intake exhibited a significant negative association with 60-day mortality in the fully adjusted model.
• Moreover, these individuals experienced a shorter LOS and incurred lower hospitalization costs compared to their counterparts.
• Notably, no significant associations were found between CHO intake and postoperative nausea and vomiting (PONV) or blood transfusion risks.
• Equally noteworthy was the absence of reported cases of aspiration in either cohort.

The study's findings suggest that incorporating preoperative oral CHO intake could be a game-changer in enhancing outcomes for elderly patients undergoing surgical treatment for OPFs. By demonstrating a potential reduction in mortality risk and improved postoperative experiences, the study paves the way for a shift in preoperative care practices.

Limitations:

While the results are promising, the study acknowledges its limitations, including its retrospective nature and the confined scope of participation to a single institution. To solidify and expand upon these findings, the researchers call for future endeavors with larger sample sizes and extended follow-up periods. This would enable a more comprehensive exploration of the long-term impact of preoperative CHO intake and a deeper understanding of the underlying mechanisms at play. 

Further reading: Zhu et al. The association between oral carbohydrate intake before orthopedic surgery for osteoporotic fractures and outcomes in elderly patients. Journal of Orthopaedic Surgery and Research (2023) 18:966. https://doi.org/10.1186/s13018-023-04458-1