Effect of preoperative carbohydrate intake on inflammatory factors and clinical outcomes in elderly patients undergoing radical prostatectomy: a single-center, double-blind randomized controlled trial

BACKGROUND: To investigate the advantages of Carbohydrate (CHO) in inflammatory markers, comfort and clinical outcomes in elderly patients undergoing open radical prostatectomy.METHODS: Patients of ≥65 years old with radical prostatectomy who underwent open radical prostatectomy were randomized to the CHO group, water group, and fasted group. Patients in the CHO group and water group received oral CHO, 800 ml of placebo water before surgery, and oral CHO and placebo water 400 ml 2 to 3 hours before surgery; the fasted group did not drink any liquid. The main outcomes are inflammatory markers. The secondary outcomes are cellular immunity, comfort, the index of grip strength of body mass and clinical outcomes.RESULTS: A total of 90 patients were included in current study (i.e., CHO group, n=28; water group, n=30; fasted group, n=32). The three groups matched well in age, body mass index, the grade of (American Society of Anesthesiologists) ASA, operation time, blood loss, and fluid volume. CHO reduces IL-6 of Day1 and Day7 (P = 0.009, 0.005, respectively), IL-8 (P=0.005) of Day1, Day1, Day 3, and Day 7 TNF (P = 0.001, 0.006, 0.003 respectively) compared with the fasted group ; placebo water reduced Day 1 and Day 7 TNF (P = 0.005, 0.038, respectively), Day 1of IL-8 (P = 0.045). CHO reduced Day3 of TNF (P=0.026) compared to placebo water. In the CHO group and the water group, the morning thirst scores (0.68, 1.26, respectively) and starvation (0.24, 0.47, respectively) were decreased. The first time to leave bed in the fasted group (39.21 (15-93) h) was much later than in the CHO group (28.57 (10-100) h) and the water group (28.71 (12-70) h).Conclusion: Compared with routine water ban, preoperative CHO and placebo water can reduce the levels of IL-6, IL-8 and TNF in elderly patients undergoing radical prostatectomy, which can improve the patient's preoperative comfort and shorten the patient's first time to leave bed. Compared with placebo water, CHO has no significant advantage in improving inflammatory markers and clinical outcomes.