Oral Carbohydrate Administration in Patients Undergoing Cephalomedullary Nailing for Proximal Femur Fractures: An Analysis of Clinical Outcomes and Patient Satisfaction
| Autor: | Yeong Chang Lee, Suc-Hyun Kweon, Jin Sung Park |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
030309 nutrition & dietetics lcsh:Geriatrics 03 medical and health sciences 0302 clinical medicine Insulin resistance Patient satisfaction lcsh:Orthopedic surgery insulin resistance Medicine Orthopedics and Sports Medicine In patient 030212 general & internal medicine Carbohydrate intake 0303 health sciences Femur fracture Proximal femur business.industry Rehabilitation Carbohydrate medicine.disease Surgery lcsh:RD701-811 lcsh:RC952-954.6 carbohydrate Original Article femur fracture Geriatrics and Gerontology business Hip Fracture Care for 2020: Best Care Best Value |
| Zdroj: | Geriatric Orthopaedic Surgery & Rehabilitation, Vol 11 (2020) Geriatric Orthopaedic Surgery & Rehabilitation |
| ISSN: | 2151-4593 |
| Popis: | Purpose: The purpose of this study was to investigate the clinical effects of oral carbohydrate intake for cephalomedullary nailing on proximal femoral fractures and patient satisfaction. Subjects and Methods: 88 patients were admitted to our hospital with proximal femoral fracture from July 2019 to December 2019. All patients were treated with closed reduction and internal fixation (CR&IF, Cephalomedullary nailing) under spinal anesthesia. The exclusion criteria included the presence of endocrine disorders including diabetes mellitus (DM), patients treated with steroids, and cognitive impairment. Additionally, those with fasting blood glucose levels above 126 mg / dl or HbA1C> 6.5% were considered as having undiagnosed DM. After obtaining informed consent, the subjects were randomized into either the preoperative oral carbohydrate (POC) group or control group. Patients who were assembled into the control group fasted including water from midnight of the day of the surgical procedure according to the conventional method. Patients assembled into the POC group received 400 ml of oral carbohydrate solution (Nucare NONPO, DAESANG, 12.8%, 1 kcal/ml)) between 21-24 hours on the day before operation and 400 ml oral carbohydrate solution 2 hours before the administration of anesthesia. Serum glucose on the day before operation at 7 am (before breakfast, baseline), immediately before anesthesia, at skin incision, 1 hour, 4 hours, 6 hours, 24 hours after anesthesia, and 3 days after surgery (before breakfast) was measured, and insulin, cortisol, and IL-6 were measured at baseline 7 am at day before operation, immediately before anesthesia, 4 hours and 24 hours after anesthesia, and 3 days after surgery (before breakfast). The patients completed questionnaires about their satisfaction (thirst, hunger, nausea and vomiting, and anxiety) in the morning (before the surgery) on the day of the surgery. Additionally, the length of hospital stay (LOS) and preoperative opioid usage was also investigated. Results: The operative characteristics of the patients did not differ between the groups except for the actual fasting time. The glucose levels were higher in the control group at skin incision; however, there were no significant differences in both groups at other time points. Additionally, insulin, insulin resistance, cortisol, and IL-6 also did not differ significantly between the 2 groups at all time-points. Among the factors related to patient satisfaction, the POC group showed significantly higher scores for thirst and hunger factors and shorter LOS than the control group. Conclusion: The intake of oral carbohydrates in patients treated with closed reduction and internal fixation for proximal femoral fractures does not affect the improvement of post-operative insulin resistance. However, there was significant improvement in patients’ thirst and hunger before surgery and LOS. |
| Databáze: | OpenAIRE |
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