术前碳水化合物负荷作为手术后增强恢复（ERAS）方案的一部分，可在选择性全髋关节置换术后早期获益。

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-06-10 DOI:10.1016/j.clnesp.2025.05.049

Shuvalaxmi D. Haselton, Vivek P. Chadayammuri, Roger H. Emerson

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引用次数: 0

摘要

背景：ERAS （Enhanced Recovery After Surgery）方案旨在优化围手术期生理机能和减少手术应激，但其在全关节置换术（TJA）中的疗效尚未完全确定。方法：2019年1月至2023年7月在单个大容量关节置换术中心进行前瞻性、随机观察性研究。共有150名接受原发性选择性THA的患者被随机分为两组，一组是遵循传统的无氧（NPO）指南的对照组，另一组是在术前12和2小时接受富含碳水化合物的口服营养补充剂的ERAS组。结果包括术后住院时间（LOS）、阿片类药物消耗（以吗啡毫克当量[MME]衡量）、视觉模拟量表（VAS）疼痛评分、90天再入院和术后早期功能里程碑。结果：ERAS组患者术后LOS降低(1.3天vs 1.8天；p = 0.048)， VAS评分峰值较低(4.5 vs. 6.0；p = 0.001)，对附表II麻醉药品的需求减少（5.3%对22.7%）。在术后前两周内，平均阿片类药物使用率（MME/day）也出现了近乎显著的下降趋势(36.1 vs 43.8；P = 0.082)。亚组分析显示，治疗效果在所有年龄段均一致。结论：在标准化ERAS方案中纳入术前碳水化合物负荷和缩短禁食与选择性THA术后早期临床结果的改善相关。采用这些措施可能是一种具有成本效益的策略，可以提高围手术期的恢复，同时与基于价值的护理交付中日益优先考虑的绩效基准保持一致。

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Preoperative carbohydrate loading as part of an enhanced recovery after surgery (ERAS) protocol confers early postoperative benefits following elective total hip arthroplasty

Background

Enhanced Recovery After Surgery (ERAS) protocols aim to optimize perioperative physiology and reduce surgical stress, yet their efficacy in total joint arthroplasty (TJA) remains incompletely characterized.

Methods

A prospective, randomized observational study was conducted at a single high-volume arthroplasty center between January 2019 and July 2023. A total of 150 patients undergoing primary elective THA were randomized to either a control group following traditional nil per os (NPO) guidelines or an ERAS group receiving a carbohydrate-rich oral nutritional supplement 12 and 2 h prior to surgery. Outcomes included postoperative length of stay (LOS), opioid consumption (measured in morphine milligram equivalents [MME]), Visual Analog Scale (VAS) pain scores, 90-day readmission, and early postoperative functional milestones.

Results

Patients in the ERAS cohort demonstrated reduced postoperative LOS (1.3 vs. 1.8 days; p = 0.048), lower peak VAS scores (4.5 vs. 6.0; p = 0.001), and decreased need for Schedule II narcotic medications (5.3 % vs. 22.7 %). A near-significant trend toward reduced average opioid utilization (MME/day) over the first two weeks postoperatively was also observed (36.1 vs. 43.8; p = 0.082). Subgroup analysis demonstrated consistent treatment effects across all age strata.

Conclusions

Incorporation of preoperative carbohydrate loading and abbreviated fasting within a standardized ERAS protocol is associated with improved early clinical outcomes following elective THA. Adoption of these measures may represent a cost-effective strategy to enhance perioperative recovery while aligning with performance benchmarks increasingly prioritized in value-based care delivery.

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.