{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T20:43:58Z","timestamp":1785789838439,"version":"3.56.0"},"reference-count":41,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Xiamen Medical and Health Guidance Project","award":["3502Z20224ZD1176"],"award-info":[{"award-number":["3502Z20224ZD1176"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,1]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hip fractures are a prevalent type of fracture and a leading cause of disability and mortality among older patients, imposing a substantial burden on both families and society. As surgical intervention is considered the primary means of improving patient outcomes, perioperative optimisation management is essential for enhancing prognosis. A key component of the Enhanced Recovery After Surgery (ERAS) protocol for hip surgery is the innovation of preoperative fasting concepts, which includes the recommendation of preoperative oral carbohydrates for surgical procedures, particularly hip surgery. While preoperative oral carbohydrates have been shown to alleviate hunger and thirst symptoms in patients and promote postoperative recovery, concerns regarding intraoperative aspiration and gastric content retention persist, rendering the safety and feasibility of this approach for surgery a topic of debate. This study aims to investigate and summarise the clinical outcomes of preoperative oral carbohydrates in patients undergoing hip surgery, providing a comprehensive evaluation of their impact on patient recovery and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      A systematic and comprehensive search will be conducted across multiple databases, including CINAHL, PubMed, CNKI, VIP database, Wanfang database, Embase, CBM, Web of Science, Cochrane Central Register of Controlled Trials and\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\/\">ClinicalTrials.gov<\/jats:ext-link>\n                      (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\/\">https:\/\/www.clinicaltrials.gov\/<\/jats:ext-link>\n                      ), from their inception to November 2024, to identify randomised controlled trials that examine the effect of preoperative oral carbohydrates on patients with hip fractures. The primary outcome of interest will be postoperative insulin sensitivity. The literature search will be screened independently by two researchers to identify eligible articles for inclusion in this meta-analysis. Subsequent data extraction and assessment of risk of bias will be performed. This meta-analysis will provide a comprehensive summary of the available data for each outcome, provided that sufficient data are available. The presence of heterogeneity among the included studies will be evaluated using the \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      test and the I\n                      <jats:sup>2<\/jats:sup>\n                      statistic, allowing for the quantification of inconsistency across the studies. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols are adhered to in this systematic review and meta-analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study uses previously published data, and as such, does not require additional ethical approval. The findings will be disseminated through peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42024611468.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-097738","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T02:30:30Z","timestamp":1758594630000},"page":"e097738","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of preoperative oral carbohydrate on clinical outcomes of patients undergoing hip fracture surgery: a protocol for systematic review and meta-analysis of randomised controlled trials"],"prefix":"10.1136","volume":"15","author":[{"given":"Qiuqin","family":"Xu","sequence":"first","affiliation":[{"name":"Xiamen Hospital, Dongzhimen Hospital, Beijing University of Chinese Medicine, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0091-370X","authenticated-orcid":false,"given":"Hongzhan","family":"Jiang","sequence":"additional","affiliation":[{"name":"School of Nursing, Beijing University of Chinese Medicine, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenting","family":"Luo","sequence":"additional","affiliation":[{"name":"Xiamen Hospital, Dongzhimen Hospital, Beijing University of Chinese Medicine, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihong","family":"Xiao","sequence":"additional","affiliation":[{"name":"Xiamen Hospital, Dongzhimen Hospital, Beijing University of Chinese Medicine, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomei","family":"Lin","sequence":"additional","affiliation":[{"name":"Xiamen Hospital, Dongzhimen Hospital, Beijing University of Chinese Medicine, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana","family":"Li","sequence":"additional","affiliation":[{"name":"Xiamen Hospital, Dongzhimen Hospital, Beijing University of Chinese Medicine, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"2025111921301272000_15.9.e097738.1","doi-asserted-by":"publisher","DOI":"10.12968\/hmed.2020.0555"},{"key":"2025111921301272000_15.9.e097738.2","article-title":"Arthroplasties for hip fracture in adults","volume":"2","author":"Lewis","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"2025111921301272000_15.9.e097738.3","doi-asserted-by":"crossref","DOI":"10.1186\/s40001-021-00556-0","article-title":"Management of proximal femur fractures in the elderly: current concepts and treatment options","volume":"26","author":"Fischer","year":"2021","journal-title":"Eur J Med Res"},{"key":"2025111921301272000_15.9.e097738.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-016-0332-0","article-title":"A critical review of the long-term disability outcomes following hip fracture","volume":"16","author":"Dyer","year":"2016","journal-title":"BMC Geriatr"},{"key":"2025111921301272000_15.9.e097738.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-021-02514-1","article-title":"Prognostic factors of depression and depressive symptoms after hip fracture surgery: systematic review","volume":"21","author":"Milton-Cole","year":"2021","journal-title":"BMC Geriatr"},{"key":"2025111921301272000_15.9.e097738.6","doi-asserted-by":"crossref","unstructured":"Palm H . Hip fracture: the choice of surgery. In: Falaschi P , Marsh D , eds. Orthogeriatrics: the management of older patients with fragility fractures. Cham (CH): Springer, 2021.","DOI":"10.1007\/978-3-030-48126-1_9"},{"key":"2025111921301272000_15.9.e097738.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.d3304","article-title":"Management of hip fracture in adults: summary of NICE guidance","volume":"342","author":"Ftouh","year":"2011","journal-title":"BMJ"},{"key":"2025111921301272000_15.9.e097738.8","doi-asserted-by":"crossref","DOI":"10.3390\/nu11051088","article-title":"Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology","volume":"11","author":"Bisch","year":"2019","journal-title":"Nutrients"},{"key":"2025111921301272000_15.9.e097738.9","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9378(16)39829-5"},{"key":"2025111921301272000_15.9.e097738.10","article-title":"Liberal preoperative fasting in adults undergoing elective surgery: a scoping review protocol","volume":"2024","author":"Gan","year":"2024","journal-title":"Anesthesiol Res Pract"},{"key":"2025111921301272000_15.9.e097738.11","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/anae.14500","article-title":"Pre-operative fasting in adults and children: clinical practice and guidelines","volume":"74","author":"Fawcett","year":"2019","journal-title":"Anaesthesia"},{"key":"2025111921301272000_15.9.e097738.12","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/j.clnu.2020.08.033","article-title":"Fasting and surgery timing (FaST) audit","volume":"40","author":"El-Sharkawy","year":"2021","journal-title":"Clin Nutr"},{"key":"2025111921301272000_15.9.e097738.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2009.04.014"},{"key":"2025111921301272000_15.9.e097738.14","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1001\/jamasurg.2016.4952","article-title":"Enhanced recovery after surgery: a review","volume":"152","author":"Ljungqvist","year":"2017","journal-title":"JAMA Surg"},{"key":"2025111921301272000_15.9.e097738.15","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1016\/j.otc.2022.07.011","article-title":"Enhanced recovery after surgery: a quality improvement approach","volume":"55","author":"Kitchin","year":"2022","journal-title":"Otolaryngol Clin North Am"},{"key":"2025111921301272000_15.9.e097738.16","article-title":"Efficacy of Enhanced Recovery After Surgery (ERAS) protocols in emergency colorectal surgery: a meta-analytical comparison with conventional care in terms of outcomes and complications","volume":"16","author":"Ahmed","year":"2024","journal-title":"Cureus"},{"key":"2025111921301272000_15.9.e097738.17","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1016\/j.jmig.2021.01.024","article-title":"A full enhanced recovery after surgery program in gynecologic laparoscopic procedures: a randomized controlled trial","volume":"28","author":"Ren","year":"2021","journal-title":"J Minim Invasive Gynecol"},{"key":"2025111921301272000_15.9.e097738.18","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1097\/SLE.0000000000001184","article-title":"Factors influencing postoperative recovery time of patients with gastric cancer","volume":"33","author":"Shao","year":"2023","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"2025111921301272000_15.9.e097738.19","doi-asserted-by":"crossref","first-page":"14","DOI":"10.35366\/112808","article-title":"Impact of the \u201c\u2018Enhanced Recovery After Surgery\u2019\u201d program in knee arthroplasty at the institutional level","volume":"37","author":"Hern\u00e1ndez-Romero","year":"2023","journal-title":"Acta Ortop Mex"},{"key":"2025111921301272000_15.9.e097738.20","doi-asserted-by":"crossref","DOI":"10.1186\/s13018-020-01586-w","article-title":"The efficacy of Enhanced Recovery after Surgery (ERAS) for elderly patients with intertrochanteric fractures who received surgery: study protocol for a randomized, blinded, controlled trial","volume":"15","author":"Yin","year":"2020","journal-title":"J Orthop Surg Res"},{"key":"2025111921301272000_15.9.e097738.21","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6963"},{"key":"2025111921301272000_15.9.e097738.22","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-020-04462-4","article-title":"Fast-track- recovery surgery with a whey-protein-infused carbohydrate-loading drink pre-operatively and early oral feeding post-operatively among surgical gynaecological cancer patients: study protocol of an open-labelled, randomised controlled trial","volume":"21","author":"Ho","year":"2020","journal-title":"Trials"},{"key":"2025111921301272000_15.9.e097738.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2004.06.009"},{"key":"2025111921301272000_15.9.e097738.24","first-page":"727","article-title":"A randomized controlled trial of preoperative carbohydrate drinks on postoperative walking capacity in elective colorectal surgery","volume":"28","author":"Wongyingsinn","year":"2019","journal-title":"Asia Pac J Clin Nutr"},{"key":"2025111921301272000_15.9.e097738.25","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.clnu.2010.09.008","article-title":"A randomized crossover study of the effects of glutamine and lipid on the gastric emptying time of a preoperative carbohydrate drink","volume":"30","author":"Awad","year":"2011","journal-title":"Clin Nutr"},{"key":"2025111921301272000_15.9.e097738.26","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1002\/bjs.10408","article-title":"Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery","volume":"104","author":"Amer","year":"2017","journal-title":"Br J Surg"},{"key":"2025111921301272000_15.9.e097738.27","doi-asserted-by":"crossref","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst Rev"},{"key":"2025111921301272000_15.9.e097738.28","unstructured":"Thomas WJJ , Chandler J , Cumpston M , et al . Cochrane handbook for systematic reviews of interventions. 2011. Available: http:\/\/www.cochrane-handbook.org"},{"key":"2025111921301272000_15.9.e097738.29","doi-asserted-by":"crossref","first-page":"3096","DOI":"10.1111\/jocn.14919","article-title":"Are carbohydrate drinks more effective than preoperative fasting: a systematic review of randomised controlled trials","volume":"28","author":"Noba","year":"2019","journal-title":"J Clin Nurs"},{"key":"2025111921301272000_15.9.e097738.30","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2025111921301272000_15.9.e097738.31","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.12"},{"key":"2025111921301272000_15.9.e097738.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0298526","article-title":"Do statistical heterogeneity methods impact the results of meta- analyses? A meta epidemiological study","volume":"19","author":"Mheissen","year":"2024","journal-title":"PLoS One"},{"key":"2025111921301272000_15.9.e097738.33","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7411"},{"key":"2025111921301272000_15.9.e097738.34","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jclinepi.2023.02.003","article-title":"Synthesis methods other than meta-analysis were commonly used but seldom specified: survey of systematic reviews","volume":"156","author":"Cumpston","year":"2023","journal-title":"J Clin Epidemiol"},{"key":"2025111921301272000_15.9.e097738.35","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline","volume":"368","author":"Campbell","year":"2020","journal-title":"BMJ"},{"key":"2025111921301272000_15.9.e097738.36","article-title":"Physical exercise for people with cirrhosis","volume":"12","author":"Aamann","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2025111921301272000_15.9.e097738.37","doi-asserted-by":"publisher","DOI":"10.1111\/j.0006-341X.2000.00455.x"},{"key":"2025111921301272000_15.9.e097738.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.015"},{"key":"2025111921301272000_15.9.e097738.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2011.01.012"},{"key":"2025111921301272000_15.9.e097738.40","doi-asserted-by":"crossref","unstructured":"Handoll HH , Cameron ID , Mak JC , et al . Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 2009.:CD007125. doi:10.1002\/14651858.CD007125.pub2","DOI":"10.1002\/14651858.CD007125.pub2"},{"key":"2025111921301272000_15.9.e097738.41","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.jopan.2022.08.012","article-title":"Effect of oral carbohydrate solution administered before hip arthroplasty on preoperative anxiety and postoperative patient comfort: a randomized controlled trial","volume":"38","author":"Ertural","year":"2023","journal-title":"J Perianesth Nurs"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-097738","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T05:30:24Z","timestamp":1763616624000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-097738"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":41,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,22]]},"published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1136\/bmjopen-2024-097738"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-097738","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]}}}