Another potential benefit of preoperative carbohydrate loading is a decrease in postoperative nausea.1,5,12-14 A decrease in nausea in theory would allow for earlier mobilization with physical therapy and potentially a shorter LOS. Hence, the goal of this study was to examine the impact of preoperative carbohydrate loading on postoperative nausea directly, as well as on LOS, at a single institution in the setting of an ERAS protocol.
Methods
Patients and Setting
We retrospectively reviewed the records of 100 patients who underwent total hip or total knee replacement between 2014 and 2018 at NYU Winthrop University Hospital, Mineola, NY. Fifty patients had received preoperative carbohydrate supplements and 50 patients had not. The remainder of the total joint protocol was identical for the 2 groups.
Protocol
All patients attended preoperative educational classes. For patients receiving carbohydrate loading, written and oral instructions were given for the patient to drink Ensure Clear followed by 8 ounces of water before going to bed the night before surgery. They were also instructed to drink the Ensure Pre-Surgery Drink 2 hours prior to their operative procedure. Patients with diabetes were instructed to drink the Ensure Glucerna Clear drink the night before surgery. No carbohydrate drink was given on the day of surgery until a finger-stick glucose level was performed upon arrival at the hospital. Spinal anesthesia was utilized in all patients, with adductor canal block supplementation for patients undergoing total knee replacement. Orders were written to have physical therapy evaluate the patients in the PACU to facilitate ambulation. Pre- and postoperative pain protocols were identical for the 2 groups.
Data Collection
A chart review was performed using the patients’ medical record numbers from the joint replacement database at our institution. Exemption was obtained for the project from our institution’s Institutional Review Board (IRB). The medical record was reviewed for the patient’s age, sex, procedure, surgeon, LOS (in days), documentation of postoperative nausea, and number of doses of antiemetic medication given to the patient on postoperative day (POD) 0 and 1. Antiemetic medication was either trimethobenzamide, metoclopramide, or ondansetron. Data was organized in an Excel spreadsheet.
Analysis
Descriptive statistics (mean, standard deviation, and median for continuous variables; frequencies and percentages for categorical variables) were calculated separately by group. The 2 groups were compared using the chi-square test or Fisher’s exact test, as deemed appropriate, for categorical variables, the 2-sample t-test for age, and the Mann-Whitney test for LOS and number of antiemetic doses given. A result was considered statistically significant at the P < 0.05 level of significance. All analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC).