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Am J Perinatol 2024; 41(S 01): e362-e368
DOI: 10.1055/s-0042-1754405
Original Article

Enhanced Recovery after Surgery for Cesarean Delivery: A Quality Improvement Initiative

Kathy C. Matthews 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York Presbyterian, Weill Cornell Medicine, New York, New York
,
Robert S. White
2   Department of Anesthesiology, New York Presbyterian, Weill Cornell Medicine, New York, New York
,
Julie Ewing
3   Department of Information Technology, NYP Analytics, New York Presbyterian Hospital, New York, New York
,
Sharon E. Abramovitz
2   Department of Anesthesiology, New York Presbyterian, Weill Cornell Medicine, New York, New York
,
Robin B. Kalish
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York Presbyterian, Weill Cornell Medicine, New York, New York
› Author Affiliations Funding None.
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Abstract

Objective Enhanced recovery after surgery (ERAS) was developed as a way to standardize clinical care pathways and communication across multidisciplinary teams to improve patient recovery and reduce hospital length of stay (LOS). Our objective was to implement an ERAS protocol for cesarean delivery (ERAS-CD) and evaluate its efficacy in reducing LOS.

Study Design An ERAS-CD program was implemented at our institution in October 2018. Patients undergoing scheduled and unscheduled CD were maintained on an ERAS pathway of care, which included preoperative hydration, standardized intraoperative protocols, and postoperative analgesic regimens as well as early feeding, urinary catheter removal, and ambulation. We compared LOS after delivery (calculated from time of delivery to discharge), readmission rates, health care disparities and postoperative opioid prescribing practices before (October 2017–September 2018) and after (November 2018–October 2019) ERAS implementation. We excluded any outliers, defined as a LOS >25 days. Continuous data are expressed as mean ± standard deviation. Student's t-test and Chi-square were used for statistical comparison with p <0.05 considered statistically significant.

Results There were 1,729 patients who had a CD in the pre-ERAS group with a mean LOS after delivery of 3.32 ± 6.19 days. In the post-ERAS group, 1,753 women underwent CD with a mean LOS after delivery of 2.85 ± 5.79 days, a statistically significant difference from the pre-ERAS group (p <0.001). There was no difference in readmission rates between pre- and post-ERAS implementation groups (1.9 vs. 2.2%, p = 0.53). There was a reduction in health care disparities in postoperative LOS, when stratifying by race-ethnicity, and a reduction in opioid prescribing practices after the implementation of the program.

Conclusion With the implementation of an ERAS-CD program, we achieved a reduced LOS, without increasing readmission rates, and saw a reduction in health care disparities and opioid dispensing. A shorter LOS could offer an enhanced patient experience, as well as improved and equitable perioperative outcomes.

Key Points

  • ERAS-CD is associated with a reduction in postoperative hospital length of stay.

  • A reduction in health care disparities by race-ethnicity was observed with the implementation of ERAS-CD.

  • A reduction in opioid dispensing was observed with the implementation of ERAS-CD.

Keywords

enhanced recovery after surgery - cesarean delivery - length of stay - health care disparities - opioid prescribing - obstetric - perioperative - postoperative - quality improvement - race-ethnicity

Note

Findings of this study were presented at the Society for Maternal-Fetal Medicine's 41st Annual Pregnancy Meeting, held virtually, January 25th to 30th, 2021.


Supplementary Material



Publication History

Received: 22 October 2021

Accepted: 17 June 2022

Article published online:
22 August 2022

© 2022. Thieme. All rights reserved.

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