Background

Pre-operative carbohydrate loading is a component of Enhanced Recovery After Surgery (ERAS) protocols, but there is limited literature in bariatric surgery patients. The objective of this study was to characterize the impact of pre-operative carbohydrate loading on post-operative bariatric surgery outcomes.

Methods

Patients undergoing a primary minimally invasive Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2018 and 2020 were randomized to standard management or intervention. Standard management patients were nothing by mouth after midnight prior to surgery. Intervention patients consumed two carbohydrate drinks: one the night before and the second three hours prior to surgery. Primary outcomes analyzed included post-operative nausea and vomiting (PONV), length of stay, and overall complications.

Results

In total, 134 patients were analyzed, 64 intervention patients (47.8%) and 70 (52.2%) standard patients. There was no statistically significant difference in length of stay (2.0 +- 1.2 days vs 2.1 +- 0.9 days; p = 0.65) or post-operative outcomes between the two groups (Table 1). There were no episodes of aspiration or post-operative pneumonia among the intervention group. Among RYGB patients, intervention patients had a shorter duration of nausea compared to standard patients. There was no statistically significant difference in perioperative glycemic control or complications among patients with and without diabetes.

Conclusions

Pre-operative carbohydrate drinks can be administered to bariatric surgery patients without significant risks. Carbohydrate loading pre-operatively can decrease the duration of PONV in RYGB patients. Carbohydrate drinks can be safely included in bariatric ERAS protocols for patients with and without diabetes.