How does the ERAS protocol work in patients who underwent cesarean section? (HERMES study)

Area of Science:

• Obstetrics and Gynecology
• Surgical Recovery Protocols
• Postpartum Care

Background:

• Cesarean delivery (CD) is a common surgical procedure with potential for delayed postoperative recovery.
• Enhanced Recovery After Surgery (ERAS) protocols aim to optimize patient outcomes and reduce recovery time.
• The specific impact of ERAS on cesarean delivery recovery, particularly with novel dietary interventions, requires further investigation.

Purpose of the Study:

• To evaluate the effectiveness of an ERAS protocol on postoperative outcomes following cesarean deliveries (CD).
• To assess the impact of early oral intake (ice cream, coffee), multimodal analgesia, antiemetics, and early ambulation on recovery.
• To compare outcomes between patients managed with the ERAS protocol and a control group.

Main Methods:

• A multicenter prospective cohort study involving 448 women undergoing planned or unplanned CD.
• The intervention group followed an ERAS protocol including early oral intake, analgesia, antiemetics, and ambulation.
• The primary outcome was time to first passage of flatus; secondary outcomes included pain, complications, and satisfaction.

Main Results:

• The ERAS protocol group experienced a significantly faster return of bowel function (median 10 hours vs. 18 hours, P < 0.001).
• Postoperative pain scores (Visual Analog Scale) were lower in the ERAS group.
• Patient satisfaction and complication rates did not significantly differ between groups.

Conclusions:

• The ERAS protocol, featuring early ice cream and coffee consumption, accelerates bowel function recovery and facilitates early discharge after cesarean delivery.
• Implementation of this ERAS protocol for both planned and unplanned CDs is safe and effective.
• ERAS protocols represent a valuable strategy for improving postoperative recovery in cesarean delivery patients.