Effect of Early Postoperative Oral Carbohydrate Intake on Nutritional Metabolism and Insulin Resistance in Elderly Patients Undergoing Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Effect of Early Postoperative Oral Carbohydrate Intake on Nutritional Metabolism and Insulin Resistance in Elderly Patients Undergoing Total Knee Arthroplasty: A Prospective Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Early Postoperative Oral Carbohydrate Intake on Nutritional Metabolism and Insulin Resistance in Elderly Patients Undergoing Total Knee Arthroplasty: A Prospective Randomized Controlled Trial Pu Chen, Xiaodan Zhang, Jie Wei, Degao Ge, Liu Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8946026/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background : Prolonged fasting after total knee arthroplasty (TKA) surgery can lead to complications such as severe thirst, hypoalbuminemia, and increased insulin resistance. However, evidence supporting the benefits of early postoperative oral carbohydrate administration in elderly patients undergoing knee arthroplasty remains limited. This study aims to evaluate the safety and efficacy of early postoperative oral carbohydrate supplementation within this patient population. Methods : This single-center, prospective, single-blind, randomized controlled trial included patients aged ≥ 65 years who were undergoing total knee arthroplasty (TKA). Postoperatively, patients in the Postanesthesia Care Unit (PACU) were randomly assigned in a 1:1 ratio to either the Early Oral Feeding(EOF) group or the Traditional Fasting (C) group. The primary outcome measure was the serum prealbumin level on postoperative day 1. Secondary outcome measures included the insulin resistance index on preoperative day 1, as well as on postoperative days 1 and 3; serum prealbumin and retinol-binding protein levels measured the day before surgery, on postoperative day 1, and on postoperative day 3; thirst scores assessed at 2, 6, and 8 hours postoperatively; degree of abdominal distension within 24 hours postoperatively; incidence and severity of nausea and vomiting; frequency of antiemetic medication use within 24 hours postoperatively; incidence of hypoxemia and aspiration within 24 hours postoperatively; time to first ambulation; time to first flatus; length of hospital stay; and patient satisfaction. Results : A total of 61 patients were analyzed (32 in the EOF group and 29 in the C group), with no significant differences in demographic or surgical characteristics between the groups. Serum prealbumin and retinol-binding protein levels did not differ significantly between the groups on postoperative days 1 and 3 (P > 0.05). However, the insulin resistance index on postoperative day 1 was significantly lower in the EOF group than in the C group (P < 0.05). Additionally, the EOF group had lower blood glucose levels on postoperative day 1 (P < 0.05) and reported higher patient satisfaction and improved thirst scores at 2 and 6 hours postoperatively compared to the C group (P 0.05). Furthermore, no significant differences were observed in the time to first flatus, time to ambulation, or length of hospital stay between the groups (P > 0.05). Conclusions : In elderly patients undergoing knee replacement surgery, the implementation of an early postoperative oral carbohydrate regimen—following the existing Enhanced Recovery After Surgery( ERAS )protocol which already advises preoperative carbohydrate intake 2 hours before surgery—did not lead to improvement in 24-hour nutritional metabolism. However, this regimen significantly reduced early postoperative insulin resistance and alleviated thirst, without increasing the incidence of complications. Moreover, it was associated with higher patient satisfaction. Trial registration: ClinicalTrials.gov on October 16, 2022 (registration number: NCT05603364). Early postoperative oral carbohydrate intake Total Knee Arthroplasty Serum prealbumin Insulin resistance index Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 24 Mar, 2026 Editor assigned by journal 23 Mar, 2026 Editor invited by journal 27 Feb, 2026 Submission checks completed at journal 26 Feb, 2026 First submitted to journal 26 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8946026","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":611535926,"identity":"c70562d7-007b-419c-8c72-f242e651b235","order_by":0,"name":"Pu 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Metabolism and Insulin Resistance in Elderly Patients Undergoing Total Knee Arthroplasty: A Prospective Randomized Controlled Trial","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Early postoperative oral carbohydrate intake, Total Knee Arthroplasty, Serum prealbumin, Insulin resistance index","lastPublishedDoi":"10.21203/rs.3.rs-8946026/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8946026/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Prolonged fasting after total knee arthroplasty (TKA) surgery can lead to complications such as severe thirst, hypoalbuminemia, and increased insulin resistance. However, evidence supporting the benefits of early postoperative oral carbohydrate administration in elderly patients undergoing knee arthroplasty remains limited. This study aims to evaluate the safety and efficacy of early postoperative oral carbohydrate supplementation within this patient population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This single-center, prospective, single-blind, randomized controlled trial included patients aged ≥ 65 years who were undergoing total knee arthroplasty (TKA). Postoperatively, patients in the Postanesthesia Care Unit (PACU) were randomly assigned in a 1:1 ratio to either the Early Oral Feeding(EOF) group or the Traditional Fasting (C) group. The primary outcome measure was the serum prealbumin level on postoperative day 1. Secondary outcome measures included the insulin resistance index on preoperative day 1, as well as on postoperative days 1 and 3; serum prealbumin and retinol-binding protein levels measured the day before surgery, on postoperative day 1, and on postoperative day 3; thirst scores assessed at 2, 6, and 8 hours postoperatively; degree of abdominal distension within 24 hours postoperatively; incidence and severity of nausea and vomiting; frequency of antiemetic medication use within 24 hours postoperatively; incidence of hypoxemia and aspiration within 24 hours postoperatively; time to first ambulation; time to first flatus; length of hospital stay; and patient satisfaction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 61 patients were analyzed (32 in the EOF group and 29 in the C group), with no significant differences in demographic or surgical characteristics between the groups. Serum prealbumin and retinol-binding protein levels did not differ significantly between the groups on postoperative days 1 and 3 (P \u0026gt; 0.05). However, the insulin resistance index on postoperative day 1 was significantly lower in the EOF group than in the C group (P \u0026lt; 0.05). Additionally, the EOF group had lower blood glucose levels on postoperative day 1 (P \u0026lt; 0.05) and reported higher patient satisfaction and improved thirst scores at 2 and 6 hours postoperatively compared to the C group (P \u0026lt; 0.05). There were no significant differences between the groups in the incidence of postoperative adverse events, including nausea, vomiting, reflux, and aspiration (P \u0026gt; 0.05). Furthermore, no significant differences were observed in the time to first flatus, time to ambulation, or length of hospital stay between the groups (P \u0026gt; 0.05). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: In elderly patients undergoing knee replacement surgery, the implementation of an early postoperative oral carbohydrate regimen—following the existing\u003cstrong\u003e \u003c/strong\u003eEnhanced Recovery After Surgery( ERAS )protocol which already advises preoperative carbohydrate intake 2 hours before surgery—did not lead to improvement in 24-hour nutritional metabolism. However, this regimen significantly reduced early postoperative insulin resistance and alleviated thirst, without increasing the incidence of complications. Moreover, it was associated with higher patient satisfaction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e ClinicalTrials.gov on October 16, 2022 (registration number: NCT05603364).\u003c/p\u003e","manuscriptTitle":"Effect of Early Postoperative Oral Carbohydrate Intake on Nutritional Metabolism and Insulin Resistance in Elderly Patients Undergoing Total Knee Arthroplasty: A Prospective Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-26 08:14:58","doi":"10.21203/rs.3.rs-8946026/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-24T16:22:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-23T07:50:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-27T09:43:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-26T19:24:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2026-02-26T08:16:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6fbd732d-de07-4588-869f-928fa54acc0e","owner":[],"postedDate":"March 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-26T08:14:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-26 08:14:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8946026","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8946026","identity":"rs-8946026","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}