Enhanced Recovery Approach to Cesarean Delivery improves outcomes, claims study

Enhanced recovery after surgery (ERAS) is a concept that combines various evidence-based aspects of perioperative care to accelerate patient recovery. It standardizes perioperative management and achieves a reproducible improvement in the quality of care. The principles of enhanced recovery cover the entire perioperative care pathway and component interventions occur during the preoperative, intraoperative, and postoperative phases of care.

With increased pressure on maternity services, several centers in Europe have begun implementing ERAS protocols for scheduled cesarean delivery, and this concept has recently started to gain popularity globally.

With this in mind, Mullman et al at the Departments of Clinical Excellence, Biostatistics, Obstetrics and Gynecology, New Jersey, undertook a study to examine the results of a quality-improvement study that implemented an enhanced recovery after surgery (ERAS) program for cesarean delivery.

The research team implemented a pre-post design to assess changes in opioid use, length of stay, and costs among all patients undergoing cesarean delivery before and after implementation of an evidence-based ERAS pathway for the preoperative, intraoperative, and postoperative management of patients beginning December 2018.

The sample population consisted of A total of 3,679 cesarean deliveries (scheduled and emergent) were included from January 1, 2018, through August 31, 2019, of which 2,171 occurred before implementation on December 17, 2018, and 1,508 occurred postimplementation.

On analysis, the following results emerged.

• Eighty-four percent of patients received opioids as inpatients after cesarean delivery during the pre-implementation period, as compared with 24% in the postimplementation period (odds ratio [OR] 16.8, 95% CI 14.3–19.9).
• Among patients who required any opioids, the total morphine milligram equivalents also significantly decreased (median 56.5 vs 15.0, mean relative change 0.32, 95% CI 0.28–0.35). Compared with the pre-implementation period, those in the postimplementation period had a shorter postcesarean length of stay (3.2 vs 2.7 days, mean relative change 0.82, 95% CI 0.80–0.83, median 3 days in both periods), lower median direct costs by $349 (mean relative change 0.93, 95% CI 0.91–0.95), and no change in the 30-day readmission rate (1.4% vs 1.7%, OR 0.83, 95% CI 0.49–1.41).

For the full article, click on the link : DOI: 10.1097/AOG.0000000000004023

Primary source: Obstetrics & Gynecology