Abstract
Enhanced recovery after surgery (ERAS) protocols have been described for patients undergoing colon surgery. Similar protocols for cesarean delivery (CD) have been developed recently. CD is one of the most commonly performed surgical procedures, and adoption of ERAS protocols following CD might benefit patients and the health-care system. We aimed to determine which Serbian hospitals reported ERAS protocols, which elements of ERAS protocols were used in CD patients, and whether ERAS and non-ERAS hospitals differed. The survey was sent to all hospitals with obstetric services and 46 of 49 responded. The questionnaire asked whether ERAS protocols had been formally adopted for surgical patients and about their use in CD patients. Specific questions on elements described in other obstetric ERAS protocols for CD included preoperative patient preparation, type of anesthesia and temperature monitoring used for CD, maternal/neonatal contact, and time to discharge. ERAS protocols are used in 24% of surveyed hospitals, 84% admit the patient the day before elective CDs, 87% use a maternal bowel preparation morning on the day of CD, and 80% administer maternal deep venous thrombosis prophylaxis. Only 33% remove IV in the first postoperative day, and 89% of women do not eat solid food until the day following their CD. Neuraxial anesthesia is used in 46% of elective CDs in ERAS hospitals compared to 9% in non-ERAS hospitals (P < 0.01), and neuraxial narcotics for post CD analgesia are given more often in ERAS hospitals. Thirty-six percentage of ERAS patients are discharged within 3 days vs. none in the non-ERAS group. Few elements of ERAS protocols reported from other centers outside Serbia are employed in Serbian hospitals performing CD. Despite significant changes that have been made recently in CD care, enhanced recovery after CD could be significantly improved in Serbian hospitals.
Highlights
The significance of enhanced recovery after surgery (ERAS) protocols has been well established in non-obstetric surgery patients and was described by Wilmore and Kehlet, 15 years ago [1]
While significant variations in Enhanced recovery after surgery (ERAS) protocols exist both within and between surgical specialties [11], common elements often include effective patient education and acceptance, good perioperative hydration and nutrition, use of surgical techniques associated with fastest patient recovery, maintenance of perioperative patient normothermia, early removal of urinary catheters, adequate pain relief that promotes early ambulation and minimal use of perioperative opioids
ERAS protocols were in use in 11 of 46 (24%) of surveyed hospitals and 63% of the time the responsibility for patients counseling was shared between the obstetrician and anesthesiologist (Table 2)
Summary
The significance of enhanced recovery after surgery (ERAS) protocols has been well established in non-obstetric surgery patients and was described by Wilmore and Kehlet, 15 years ago [1]. Enhanced recovery after surgery protocols have been developed for patients undergoing cesarean delivery (CD) in recent years. Recent guidelines of the UK National Institute for Health and Care Excellence suggest that a majority of women undergoing elective CD could be discharged on the day after delivery [14]. Such early discharges are not associated with either increased patient morbidity or higher readmission rates than in women discharged later [15]. The widespread adoption of ERAS protocols for CD was recently advocated by Lucas and Gough as a means for achieving these positive outcomes [17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
