Enhanced recovery after scheduled cesarean delivery: a prospective pre-post intervention study

Abstract

Objective To assess whether an early recovery after surgery (ERAS) pathway after scheduled cesarean delivery was associated with a reduction in postoperative length of stay compared with standard perioperative care. Methods This was a prospective pre- and post-intervention study. Women were included if they were between 18 and 45 years of age and delivered a singleton, term, non-anomalous fetus via scheduled cesarean delivery by a provider within an academic practice. The ERAS pathway consisted of 23 evidence-based components regarding preoperative, intraoperative, and postoperative care. The primary outcome was the rate of postoperative length of stay of 3 or more days. Secondary outcomes included total postoperative narcotic use, postoperative complications, 30-day hospital readmission rates, and quality of recovery questionnaire scores. Results A total of 116 women were included. There were no significant differences in patient characteristics between the pre- and post-implementation groups in the post-implementation group, surgery time was longer (78.3 ± 27.8 vs 59.1 ± 19.2 min, p < .001) and blood loss volume was higher (910.3 ± 405.1 vs 729.1 ± 202.0, p = .003), compared to pre-implementation group. An ERAS pathway was not associated in a significant reduction in postoperative length of stay of 3 or more days (70.7% vs 75.9%, p = .529). It was also not significantly associated with a difference in postoperative narcotic use, maximum pain score, transfusion, postoperative complications or hospital readmission rates. Conclusion An early recovery after surgery pathway after scheduled cesarean delivery was not associated with a reduction in postoperative length of stay or narcotic use, though the recovery scores were better after implementation.