The effects of preoperative carbohydrate intake on perioperative stress response and postoperative cognitive function in elderly patients undergoing high-risk orthopedic surgery
Zhi Xiaoyan
Wei Xiao
Liao Jiaqi
Li Jin
Gao Yunting
Tian Yi
Abstract：Objective To investigate the effects of preoperative carbohydrate intake on perioperative stress response and postoperative cognitive function in elderly patients undergoing high-risk orthopedic surgery.Methods A total of 221 elderly patients who underwent high-risk orthopedic surgery in Haikou People's Hospital,Hainan Province from January 2022 to December 2024 were enrolled.According to the preoperative treatment methods,the patients were divided into observation group(94 cases,drinking carbohydrate beverage 2 h before surgery),drinking water group(62 cases,drinking the same amount of warm water 2 h before surgery)and control group(65 cases,fasting and water deprivation before surgery).The physiological metabolic indexes[blood glucose,insulin,insulin resistance index,adrenocorticotropic hormone(ACTH)],postoperative cognitive function[mini-mental state examination(MMSE)score],postoperative quality of recovery(QoR-40 score),complications and gastric volume changes were compared among the three groups at different time points.Results There were significant differences in blood glucose and ACTH levels among the three groups at T3 time point(8:00 the next day after surgery)(all P＜0.001).There was no significant difference in MMSE scores among the three groups before and after operation(all P＞0.05).The incidence of postoperative cognitive dysfunction(POCD)in the observation group was significantly lower than that in the control group(P＜0.01).Multivariate Logistic regression analysis showed that age,preoperative MMSE score and grouping were independent influencing factors for the occurrence of POCD(all P＜0.05).The QoR-40 scores of the observation group,drinking water group and control group were 192(189,196),180(173,186)and 162(156,169),and the difference was statistically significant(P＜0.001).There was no significant difference in the incidence of reflux,aspiration,nausea and vomiting among the groups(all P＞0.05).Conclusion Preoperative carbohydrate supplementation can effectively reduce the perioperative stress response of elderly patients undergoing high-risk orthopedic surgery,improve the quality of postoperative recovery,and reduce the incidence of POCD without increasing the risk of postoperative complications.
Keywords：Elderly orthopedic surgeryPreoperative carbohydrate supplementationStress responsePostoperative cognitive dysfunction
Publication Date：2025-08-18
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：6( 1194-1199 )