Enhanced recovery with cesarean section - where are we in austria?

Abstract

Enhanced recovery after surgery (ERAS) recommendations for cesarean section, likely the most common reason for laparotomy in women, were issued in 2018-19. We examined how current perioperative management at cesarean section in Austrian hospitals and German/Austrian/Swiss clinical guidelines align with ERAS recommendations. We surveyed the 21 largest public obstetric units in Austria for alignment to 20 of the 31 strong recommendations regarding perioperative maternal care at cesarean section. We also looked at how the German-language clinical guideline for cesarean section (https://www.awmf.org/uploads/tx_szleitlinien/015-084l_S3_Sectio-caesarea_2020-06_1_02.pdf) aligns with ERAS recommendations. The 21 obstetric units reported 1,200-3,865 deliveries per year and thus cared for about 51% of all births in the country in 2019. The cesarean section rates at the 21 units ranged from 17.7% to 50.4%. No hospital had officially adopted an ERAS program for cesarean section. All 21 units implemented the five strong recommendations regarding patient information and counselling, regional anesthesia, euvolemia and multimodal analgesia. By far the least implemented strong recommendation was the one for immediate postoperative removal of a urinary catheter (4/21 units, 19%). Overall, all 21 units implemented ≥12 and 16 (76%) implemented ≥15 (≥75%) of the 20 strong recommendations; no unit implemented all 20 strong recommendations. There were no differences in the implementation of strong recommendations according to hospital volume. Even in the absence of formal adoption of ERAS programmes for cesarean section many perioperative ERAS recommendations are already being implemented in Austria. Immediate catheter removal was the least adhered to recommendation. Only 10 of the 20 ERAS recommendations we looked at are included in the current German/Austrian/Swiss clinical guideline for cesarean section.