Perioperative liberal drinking management promotes postoperative gastrointestinal function recovery after gynecological laparoscopic surgery: A randomized controlled trial.

ABSTRACT

STUDY OBJECTIVE: This study aims to evaluate the effect of perioperative liberal drinking management, including preoperative carbohydrate loading (PCL) given 2 h before surgery and early oral feeding (EOF) at 6 h postoperatively, in enhancing postoperative gastrointestinal function and improving outcomes in gynecologic patients. The hypotheses are that the perioperative liberal drinking management accelerates the recovery of gastrointestinal function, enhances dietary tolerance throughout hospitalization, and ultimately reduces the length of hospitalization. DESIGN: A prospective randomized controlled trial. SETTING: Operating room and gynecological ward in Wuhan Union Hospital. PATIENTS We enrolled 210 patients undergoing elective gynecological laparoscopic surgery, and 157 patients were included in the final analysis. INTERVENTIONS: Patients were randomly allocated in a 111 ratio into three groups, including the control, PCL, and PCL-EOF groups. The anesthetists and follow-up staff were blinded to group assignment. MEASUREMENTS The primary outcome was the postoperative Intake, Feeling nauseated, Emesis, Examination, and Duration of symptoms (I-FEED) score (range 0 to 14, higher scores worse). Secondary outcomes included the incidence of I-FEED scores >2, and other additional indicators to monitor postoperative gastrointestinal function, including time to first flatus, time to first defecation, time to feces Bristol grade 3-4, and time to tolerate diet. Additionally, we collected other ERAS recovery indicators, including the incidence of PONV, complications, postoperative pain score, satisfaction score, and the quality of postoperative functional recovery at discharge. MAIN RESULTS: The PCL-EOF exhibited significantly enhanced gastrointestinal function recovery compared to control group and PCL group (p < 0.05), with the lower I-FEED score (PCL 0[0,1] vs. PCL-EOF 0[0,0] vs. control 1[0,2]) and the reduced incidence of I-FEED >2 (PCL8% vs. PCL-EOF 2% vs. control21%). Compared to the control, the intervention of PCL-EOF protected patients from the incidence of I-FEED score > 2 [HR0.09, 95%CI (0.01-0.72), p = 0.023], and was beneficial in promoting the patient's postoperative first flatus [PCL-EOF HR3.33, 95%CI (2.14-5.19),p < 0.001], first defecation [PCL-EOF HR2.76, 95%CI (1.83-4.16), p < 0.001], Bristol feces grade 3-4 [PCL-EOF HR3.65, 95%CI (2.36-5.63), p < 0.001], first fluid diet[PCL-EOF HR2.76, 95%CI (1.83-4.16), p < 0.001], and first normal diet[PCL-EOF HR6.63, 95%CI (4.18-10.50), p < 0.001]. Also, the length of postoperative hospital stay (PCL-EOF 5d vs. PCL 6d and control 6d, p < 0.001), the total cost (PCL-EOF 25052 ± 3650y vs. PCL 27914 ± 4684y and control 26799 ± 4775y, p = 0.005), and postoperative VAS pain score values [POD0 (PCL-EOF 2 vs. control 4 vs. PCL 4, p < 0.001), POD1 (PCL-EOF 1 vs. control 3 vs. PCL 2, p < 0.001), POD2 (PCL-EOF 1 vs. control2 vs. PCL 1, p < 0.001), POD3 (PCL-EOF 0 vs. control 1 vs. PCL 1, p < 0.001)] were significantly reduced in PCL-EOF group. CONCLUSIONS: Our primary endpoint, I-FEED score demonstrated significant reduction with perioperative liberal drinking, serving as a protective intervention against I-FEED>2. Gastrointestinal recovery metrics, such as time to first flatus and defecation, also showed substantial improvements. Furthermore, the intervention enhanced postoperative dietary tolerance and expedited early recovery. TRIAL REGISTRATION ChiCTR2300071047(https//www.chictr.org.cn/).