Practical significance and assessment of gastric ultrasound in preoperative carbohydrate loading: A retrospective analysis of 746 patients within the Enhanced Recovery After Surgery Pathway.

Background: Although preoperative carbohydrate loading (PCL) is generally regarded as safe, the significance of assessing gastric status by gastric ultrasound after PCL application has not been adequately explored in real-world clinical settings. Therefore, this study evaluated gastric status after PCL using gastric ultrasound and its potential role in enhancing patient safety within a large surgical cohort under Enhanced Recovery After Surgery (ERAS) protocols.

Methods: We retrospectively analyzed patients who received PCL and underwent hepatobiliary surgery within ERAS protocol between November 2018 to December 2023. The primary outcome was the incidence of an increased gastric content. Secondary outcomes included PCL compliance, gastric ultrasound data, fasting intervals, the incidence of rapid sequence intubation (RSI) and aspiration, and predictive factors for increased gastric content.

Results: Of the 1,187 patients, the compliance rate for PCL applications within the ERAS protocol reached 88%, with 746 patients included in the final analysis. Fasting hours duration < 2 hours in 7.2% of cases. The incidence of an increased gastric content was 4.8% (95% confidence interval [CI] 3.5-6.6%), observed in 36 patients. RSI was performed in all patients with an increased gastric content, with no aspiration reported. Multivariate logistic regression identified BMI as the only independent predictor of increased gastric content (OR 0.66, 95% CI 0.57-0.77, P <  0.001).

Conclusions: Patients receiving PCL within the ERAS protocol may be safe in clinical practice without an elevated risk of having an increased gastric content. However, individual variability and associated risk factors need consideration.

Registration: Not applicable.