Effects of postoperative oral carbohydrate intake immediately on the quality of recovery: a propensity score-matched and multivariate analysis.

Abstract

Purpose: This study aimed to evaluate the efficacy of postoperative oral carbohydrate (CHO) supplementation immediately compared with plain water in improving recovery outcomes in patients undergoing knee arthroplasty (KA). Additionally, we analyzed the influence of perioperative factors on the quality of postoperative recovery.

Methods: We included 200 patients who underwent knee arthroplasty between August 2022 and August 2024. A 1:1 propensity score matching (PSM) was applied to adjust for confounding variables and group differences. Multivariate logistic regression identified factors impacting the quality of recovery.

Results: After 1:1 PSM, the carbohydrate group comprised 78 patients, and the water group included 78 patients. The results indicated that postoperative oral carbohydrate supplementation improved the QoR-15 score at 24 h (123.7 ± 12.9 vs. 119.7 ± 12.5, p = 0.049). It also reduced HOMA-IR at 24 h (p < 0.001), decreased hunger and anxiety levels at 6 h (p < 0.001), shortened the time to first flatus and bowel movement (p < 0.001), and reduced the duration of hospital stay (p = 0.001). Female sex (OR = 0.455, p = 0.015), lower BMI (OR = 0.846, p = 0.005), and intraoperative music intervention (OR = 3.050, p < 0.001) were significant factors for improving recovery.

Conclusions: Postoperative oral carbohydrate supplementation immediately improves recovery quality, reduces HOMA-IR, alleviates hunger and anxiety, and accelerates gastrointestinal recovery in knee arthroplasty patients. Sex, BMI, and intraoperative music are significant factors affecting recovery outcomes.