Abstract:

Objective To evaluate the effectiveness and safety of preoperative carbohydrate administration on  insulin resistance after  colorectal surgery,and to provide basis for clinical treatment.MethodsAccording to the criteria of systematic reviews,a thorough literature search related to  randomized controlled trials (RCTs) for effectiveness and safety evaluation of preoperative carbohydrate administration on insulin resistance after  colorectal surgery was performed among China Journal Full-text Database,Chinese Biomedical Database,Chinese Scientific Journals Full-text Database,CMA Digital Periodicals,PubMed,Cochrane Library,Embase,ISI Web of Knowledge,and the hand search on relevant journals was performed as a supplement.The methodological qualities of the included literatures were assessed by Cochrane Handbook Version 5.0. RevMan 5.0 software was used for Meta-analysis of seven included RCTs.Results Seven RCTs involving 728 participants were included.It was controversial that preoperative oral carbohydrate administration could increase insulin sensitive index (ISI) (SMD=－0.38,95%CI=－0.65—－0.11,I2 = 94%) and decrease insulin resistance index (IRI) (SMD=－1.82,95%CI=－2.67—－0.98) compared with preoperative fasting group;however,preoperative oral carbohydrate administration could decline the preoperative hunger,anxiety and thirst. Compared with preoperative placebo,preoperative oral carbohydrate administration could increase ISI (SMD= 1.06,95%CI= 0.32－1.81) and decreaseIRI (SMD=－1.34,95%CI=－2.12—－0.57).The level of postoperative insulin (SMD= 3.51,95%CI= 2.99－4.03) was increased and the level of insulin in the 1st day after surgery (SMD= 0.65,95%CI= 0.31－0.98) was increased in  preoperative oral carbohydrate administration group compared with  preoperative intravenous glucose injection group.The  hospitalization time  of patients in preoperative oral carbohydrate administration group was longer than that in postoperative  intravenous glucose injection group (SMD= 0.45,95%CI= 0.12－0.78).Conclusion Preoperative oral carbohydrate administration can reduce preoperative hunger,anxiety and thirst  compared with preoperative fasting,and increase ISI and decrease IRI  compared with preoperative placebo.Preoperative intravenous glucose injection  can increase postoperative ISI and shorten  hospitalization time  compared with preoperative oral carbohydrate administration.

Key words: preoperative carbohydrate administ
ration, colorectal surgery, quality
 evaluation, randomized controlled trials, Meta-analysis