The role of carbohydrate drinks in preoperative nutrition: comment 1

The role of carbohydrate drinks in preoperative nutrition for elective colorectal surgery. I enjoyed reading and entirely agree with the findings of the review by Jones et al on the role of carbohydrate (CHO) drinks in preoperative nutrition for elective colorectal surgery but I offer a word of caution. No mention was made of the possible increased risk of surgical site infection (SSI) that may be caused by this action, even in non-diabetic patients. Tight control of perioperative blood sugar in patients who have diabetes is one of the high impact interventions advocated by the Department of Health to reduce the risk of SSI. 1 In addition, there is compelling evidence that poorly controlled, perioperative blood sugar, even in non-diabetic patients, may significantly increase deep sternal wound SSI rates in patients having cardiac surgery. 2 In these days of enhanced recovery after surgery (ERAS), the increasing use of a laparoscopic approach (particularly for elective colorectal surgery) and optimal use of anaesthesia 3 (both of which minimise the metabolic response to trauma) may make this caution unnecessary with regard to SSI. However, I should be interested to know if Jones et al found any increased incidence of SSI in their meta-analysis when preoperative CHO drinks had been used prior to open elective colorectal surgery. If this were found to be the case, closer control of blood sugar ought to be considered in the perioperative period. The Society of Thoracic Surgeons practice guideline series: blood glucose management during adult cardiac surgery. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. We read with interest the review of Jones et al looking at the role of CHO drinks in perioperative nutrition for elec-tive colorectal surgery. However, we have some concerns regarding the rigour of assessment of elements of the evidence base and the authors' accuracy in presentation of this evidence. The largest randomised controlled trial refer-enced (and one of only two that looked at clinical outcomes in patients undergoing colorectal surgery in the review) is that of Mathur et al. 1 The review by Jones et al states that Mathur et al showed CHO supplements reduced length of hospital stay. This is at odds with Mathur's own conclusion: 'Preoperative CHO treatment did not improve postoperative fatigue or length of hospital stay after major abdominal surgery .' 1 Furthermore, the work of Svanfeldt et al …