A systematic review and meta-analysis of preoperative carbohydrate drink loading prior to elective hip and knee arthroplasty.

Background: The Enhanced Recovery After Surgery (ERAS) program has significantly reduced complication rates and hospital length of stay (LOS) for various surgical procedures. A key aspect is the reduction of pre-operative fasting through carbohydrate-loading protocols. There is limited research on the effects of pre-operative carbohydrate loading in elective lower limb arthroplasty. This systematic review and meta-analysis evaluates the impact of pre-operative carbohydrate loading on LOS, pain scores, postoperative nausea and vomiting, patient-reported outcome measures (PROMs), and patient experience in lower limb arthroplasty surgery.

Methods: The MEDLINE, Embase, CINAHL, and Cochrane Central databases underwent a comprehensive search from their inception to July 01, 2023, with an update conducted on April 01, 2024. Inclusion criteria encompassed high-quality research as determined by the AMPQQ assessment tool, focusing on preoperative carbohydrate drink loading in hip and knee arthroplasty. The review was prospectively registered on PROSPERO; registration number CRD42023420618.

Results: 1686 articles were identified. 281 duplicates were removed and 1379 articles rejected based on title and abstract review. 26 articles underwent a full-text review. A final evaluation was conducted, which included 10 articles meeting the inclusion criteria. These articles, published between 2001 and 2022, encompassed 756 patients (57-71.9 years old). While some studies indicated the potential benefits of carbohydrate loading in reducing the length of hospital stay (LOS), our meta-analysis did not demonstrate a statistically significant LOS reduction within the intervention group (mean difference of 0.47 days (95 % CI -0.98 to 0.04, p = 0.07). Furthermore, no statistically significant differences were observed in pain scores (VAS) at 24 h (p = 0.37) or in postoperative nausea and vomiting (p = 0.42) between the two groups. However, there is a possibility of improvement in anxiety levels, postoperative thirst, and hunger with carbohydrate drink loading.

Conclusion: LOS trended towards favouring pre-operative carbohydrate loading in lower limb arthroplasty surgery, however, there was significant heterogeneity within included studies. Further high-powered, multicentered studies are required to analyse whether carbohydrate drink loading is superior to 'nil by mouth' protocols.