Abstract
The objective of this study was to determine if the implementation of an Enhanced Recovery After Surgery (ERAS) protocol for Cesarean section was associated with procedure-related infection rates in the post-partum period. This project was designed as part of a prospective cohort study which compared surgical outcomes for cesarean section patients prior to and following implementation of an ERAS protocol. Primary interventions aimed at reducing surgical site infections included standardization of vaginal preparation and the addition of azithromycin antibiotic prophylaxis for laboring patients. Inclusion criteria were patients over the age of 18 who had a singleton or twin cesarean delivery at a tertiary care center between February 2019 and January 2020. We included patients of all gestational ages and all acuity levels (scheduled, urgent and emergent). Exclusion criteria were pregnancies of higher-level multiples, prolonged intensive care unit (ICU) stay following delivery. Final number of patients after exclusion criteria applied N= 339 with n=170 pre-intervention and n=169 post-intervention. On analysis of descriptive variables there were no significant differences between groups for age, BMI, parity, number of prior cesarean deliveries and acuity of procedure. Among laboring patients, there was no significant difference between groups in the percentage of patients who received azithromycin with (87.95% pre-intervention and 87.65% post-intervention, p=1.00). Only 12.35% of patients received a vaginal preparation in the pre-intervention group versus 78.7% in the post-intervention group (p<.0001). The resulting cesarean procedure-related infection rate was significantly lower in the post-intervention group with rates of 5.3% versus 11.7% in the pre-intervention group (p=0.038). An ERAS protocol including vaginal preparation for all patients regardless of gestational age or acuity of procedure is associated with decreased procedure-related infection rates.
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