original scientiﬁc paper
Eur Surg (2017) 49:180–186
Effects of preoperative carbohydrate drinks on
postoperative outcome after colorectal surgery
Zuzana Adamova · Radim Slová ˇcek
Received: 24 March 2017
Accepted: 19 June 2017
Published online: 12 July 2017
© Springer-Verlag GmbH Austria 2017
Background Overnight fasting before surgery used to
be the routine. Overnight fasting changes patients’
metabolic state and inﬂuences their perioperative
stress response. The aim of the study was to investi-
gate the effects of preoperative carbohydrate drinks
on return of bowel sounds and movement, postoper-
ative complications, and length of stay.
Methods It is a prospective non-randomized study
with 196 consecutive patients who underwent surgery
in Vsetin hospital for a diagnosis of colon or rectal
cancer from January 2010 to January 2015. Patients
were assigned into two groups – with (PreOp group)
and without (Non-PreOp group) carbohydrate drink.
We collected data regarding age, comorbidities, lo-
cal stage of tumor, urgency and type of operation.
The output variables recorded included postoperative
bowel sounds, ﬁrst stool, postoperative complications,
anastomotic leak, surgical site infections, and length
of hospital stay.
Results In the PreOp group there was faster return
of peristalsis (p = 0,033). We did not prove that the
PreOp inﬂuenced passage of stool. The total number
of postoperative complications was higher in the Non-
PreOp group than in the PreOp group, 57 (57%) vs.
30 (31%) respectively, (p = 0,0003). The most frequent
type of complication was surgical site infection (SSI).
It occurred in 17% in the PreOp group and in 34%
in the Non-PreOp group (p = 0,004). The difference
in anastomotic leak rate was not signiﬁcant. Mean
hospital stay was 13 days in the PreOp group and 16
days in the Non-PreOp group (p = 0,006).
Z. Adamova (
Surgery department, Vsetin Hospital, Nemocnicni 955, 755
01 Vsetin, Czech Republic
Conclusion Use of carbohydrate solution before the
surgery accelerates return of bowel sounds, reduces
total number of postoperative complications, SSI and
shortens the length of hospital stay. Carbohydrate
beverages should be used more widely in daily prac-
Keywords Carbohydrate drink · Preoperative nutri-
tion · Complications · Surgical site infections · Length
Major colorectal surgery carries a high risk of post-
operative complications and prolonged hospital stay.
Currently, evidence-based protocols called enhanced
recovery programs (ERAS) are expected to improve the
results of surgery. Many hospitals claim to follow fast-
track surgery recommendations, but usually the de-
gree of implementation is not so high as hoped for
[1, 2]. Some authors suggest this to be due to the or-
ganizational demands they make on surgeons, anes-
thetists, and nursing staff. For some physicians, to
change a practice followed for years is difﬁcult.
In recent years, long preoperative fasting has been
questioned. According to the current ERAS guidelines,
clear liquids are acceptable until 2 h before surgery.
This kind of management does not increase the risk
of aspiration during anesthesia. The surgical pro-
cedure itself induces the metabolic response of the
body leading to postoperative insulin resistance, hy-
perglycemia, and catabolism. The preoperative ad-
ministration of carbohydrates has beneﬁcial effects
on the metabolic response to stress, mainly by de-
creasing insulin resistance, reducing the tendency to
hyperglycemia, and decreasing catabolism, which has
been proved by some studies [3–6]. Most of the stud-
180 Effects of preoperative carbohydrate drinks on postoperative outcome after colorectal surgery