An enhanced recovery after surgery pathway for cesarean delivery decreases hospital stay and cost

Fay, Emily; Hitti, Jane; Delgado, Carlos; Savitsky, Leah M.; Mills, Elizabeth B.; Slater, JoAnn L.; Bollag, Laurent

doi:10.1016/j.ajog.2019.06.041

Cited by 83 publications

(85 citation statements)

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“…Enhanced recovery after surgery (ERAS) is a philosophy of perioperative care that has been utilized in other fields since the 1990s, yet only recently has been applied to obstetric care. [1][2][3][4][5][6][7] In various subspecialties, ERAS protocols have been shown to achieve the triple aim: increasing patient satisfaction, decreasing cost, and improving quality. 8 As key maternity care stakeholders seek to improve care quality and costs, ERAS may be a promising solution for addressing value in the postpartum period.…”

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confidence: 99%

Enhanced Recovery after Surgery for Cesarean Delivery Decreases Length of Hospital Stay and Opioid Consumption: A Quality Improvement Initiative

et al. 2020

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Objective The aim of this study is to assess the effect of a resident-led enhanced recovery after surgery (ERAS) protocol for scheduled prelabor cesarean deliveries on hospital length of stay and postpartum opioid consumption. Study Design This retrospective cohort study included patients who underwent scheduled prelabor cesarean deliveries before and after implementation of an ERAS protocol at a single academic tertiary care institution. The primary outcome was length of stay following cesarean delivery. Secondary outcomes included protocol adherence, inpatient opioid consumption, and patient-centered outcomes. The protocol included multimodal analgesia and antiemetic medications, expedited urinary catheter removal, early discontinuation of maintenance intravenous fluids, and early ambulation. Results A total of 250 patients were included in the study: 122 in the pre-ERAS cohort and 128 in the post-ERAS cohort. There were no differences in baseline demographics, medical comorbidities, or cesarean delivery characteristics between the two groups. Following protocol implementation, hospital length of stay decreased by an average of 7.9 hours (pre-ERAS 82.1 vs. post-ERAS 74.2, p < 0.001). There was 89.8% adherence to the entire protocol as written. Opioid consumption decreased by an average of 36.5 mg of oxycodone per patient, with no significant differences in pain scores from postoperative day 1 to postoperative day 4 (all p > 0.05). Conclusion A resident-driven quality improvement project was associated with decreased length of hospital stay, decreased opioid consumption, and unchanged visual analog pain scores at the time of hospital discharge. Implementation of this ERAS protocol is feasible and effective. Key Points

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Enhanced Recovery after Surgery for Cesarean Delivery Decreases Length of Hospital Stay and Opioid Consumption: A Quality Improvement Initiative

et al. 2020

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“…Childbirth is associated with emotional and physical changes; therefore, cesarean section (C/S) is a surgical procedure that changes the mother and baby interaction of the postpartum period into the postoperative period [1]. The C/S is one of the most common surgeries performed in the United States; about one-third of childbirth (nearly 1.3 million annually) is performed by C/S [2][3]. In Canada, the rate of C/S was increased from 17% of all births in 1995 to 29% in 2010-2011 [3].…”

Section: Introductionmentioning

confidence: 99%

“…This program is also known as fast-track surgery [6][7]. The ERP is a standardized interdisciplinary and evidence-based approach involving nursery teams, surgeons, anesthesiologists, and postpartum teams, to improve the care of patients who are undergoing surgeries [2,8]. The ERP is not only for humanistic purposes, but it is also used for economic purposes [1,3,[8][9].…”

Section: Introductionmentioning

confidence: 99%

“…The purpose of the program is to optimize patients' perioperative care by accelerating the patients' recovery to normal physiological state [6][7][11][12]. Also, the ERP pathway is the concept of enhancing and improving recovery from the catabolic and inflammatory body responses to surgery [2]. Further, this program had been used for patients who underwent colorectal surgeries; however, the same idea had also been used in general surgery, breast surgery, urology, orthopedics, and gynecological oncology and general gynecology [2-3, 6, 12].…”

Section: Introductionmentioning

confidence: 99%

“…Although there are some limitations to early discharge in obstetrics, including maternal acceptability, concerns about neonatal safety and establishment of breastfeeding, the National Institute for Health and Care Excellence (NICE) had integrated ERP into its guidelines [6][7]. The NICE stated if a woman after C/S recovered well and did not have complications can be offered an early discharge from the hospital within 24 hours and looked after at home [2,13]. The women after C/S without the application of this program are usually discharged home at least two to three days postoperatively [6][7].…”

Section: Introductionmentioning

confidence: 99%

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Enhanced Recovery Program after Cesarean Section in Sulaimani Maternity Teaching Hospital

Mohammed

Jawad

Murad

2020

KJAR

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Enhanced recovery program (ERP) for cesarean section (C/S) is improving patient health and is cost-effective for healthcare providers. We aimed to assess how ERP improves patient satisfaction, ambulation time, severity of pain, decrease hospital stay among patients attending Sulaimani Maternity Teaching Hospital and fetal outcome. A quasi-experimental study was performed on 200 patients in Sulaimani from June 2019 to December 2019. The participants divided into two equal groups. The intervention group was 100 women who underwent elective C/S in Sulaimani Maternity Teaching Hospital and subjected to ERP. While the control group was the other 100 women who were not subjected to the ERP, and they were from the Emergency Department of the same hospital. The women in the intervention group were supervised by anesthetists from preoperatively, intraoperatively, through postoperatively. The intervention group showed significantly better outcome regarding time to ambulate; all patients were able to ambulate 4-5 hours postoperatively. Also, the duration of hospital stay was better in the intervention group; all the patients discharged before 24 hours, but five patients in the control group discharged after 24 hours. Besides, fetal Apgar score after five minutes was also better in the intervention group; at the first minute, the mean±SD (standard deviation) of Apgar score was 8.36±1.38 and 8.08±1.69 for the intervention, and control groups, respectively (P-value = 0.2). While at five minutes, the mean±SD of Apgar score was 9.59±064, and 8.96±1.12 for the intervention, and control groups, respectively (P-value = <0.001). This intervention had favorable outcomes regarding pain, time of ambulation, and fetal Apgar score. We recommend implementing ERP at a broader scale as it gives better outcomes.

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Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

et al. 2021

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ERAS) is a global surgical quality improvement initiative now firmly entrenched within the field of perioperative care. Although ERAS is associated with significant clinical outcome improvements and cost savings in numerous surgical specialties, several opportunities and challenges deserve further discussion.OBSERVATIONS Uptake and implementation of ERAS Society guidelines, together with ERAS-related research, have increased exponentially since the inception of the ERAS movement. Opportunities to further improve patient outcomes include addressing frailty, optimizing nutrition, prehabilitation, correcting preoperative anemia, and improving uptake of ERAS worldwide, including in low-and middle-income countries. Challenges facing enhanced recovery today include implementation, carbohydrate loading, reversal of neuromuscular blockade, and bowel preparation. The COVID-19 pandemic poses both a challenge and an opportunity for ERAS. CONCLUSIONS AND RELEVANCETo date, ERAS has achieved significant benefit for patients and health systems; however, improvements are still needed, particularly in the areas of patient optimization and systematic implementation. During this time of global crisis, the ERAS method of delivering care is required to take surgery and anesthesia to the next level and bring improvements in outcomes to both patients and health systems.

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An enhanced recovery after surgery pathway for cesarean delivery decreases hospital stay and cost

Cited by 83 publications

References 20 publications

Enhanced Recovery after Surgery for Cesarean Delivery Decreases Length of Hospital Stay and Opioid Consumption: A Quality Improvement Initiative

Enhanced Recovery after Surgery for Cesarean Delivery Decreases Length of Hospital Stay and Opioid Consumption: A Quality Improvement Initiative

Enhanced Recovery Program after Cesarean Section in Sulaimani Maternity Teaching Hospital

Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

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