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

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Implementing an Enhanced Recovery After Surgery (ERAS) protocol for cesarean delivery (ERAS-CD) significantly reduced hospital length of stay (LOS). This ERAS-CD program also decreased health care disparities and opioid prescribing without increasing readmission rates.

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Area of Science:

  • Obstetrics and Gynecology
  • Surgical Patient Care
  • Health Services Research

Background:

  • Enhanced Recovery After Surgery (ERAS) protocols standardize care to improve patient outcomes and reduce hospital length of stay (LOS).
  • Cesarean delivery (CD) is a common surgical procedure, and optimizing recovery is crucial for maternal well-being.

Purpose of the Study:

  • To implement an ERAS protocol specifically for cesarean delivery (ERAS-CD).
  • To evaluate the efficacy of the ERAS-CD protocol in reducing postoperative LOS.
  • To assess the impact of ERAS-CD on readmission rates, health care disparities, and opioid prescribing.

Main Methods:

  • An ERAS-CD program was implemented, including preoperative hydration, standardized intraoperative care, and postoperative protocols for analgesia, feeding, catheter removal, and ambulation.
  • A comparative study design was used, analyzing data from before (October 2017-September 2018) and after (November 2018-October 2019) ERAS implementation.
  • Length of stay (LOS), readmission rates, health care disparities (stratified by race-ethnicity), and opioid prescribing were compared. Outliers (LOS >25 days) were excluded. Statistical analysis included Student's t-test and Chi-square tests.

Main Results:

  • The mean LOS after delivery decreased significantly from 3.32 days in the pre-ERAS group (n=1,729) to 2.85 days in the post-ERAS group (n=1,753) (p <0.001).
  • Readmission rates remained similar between the groups (1.9% vs. 2.2%, p=0.53).
  • The ERAS-CD implementation led to a reduction in health care disparities in postoperative LOS based on race-ethnicity and a decrease in postoperative opioid prescribing.

Conclusions:

  • Implementation of an ERAS-CD program effectively reduced hospital length of stay.
  • The ERAS-CD protocol demonstrated a positive impact on reducing health care disparities and opioid dispensing.
  • These findings suggest that ERAS-CD can enhance patient experience and improve perioperative outcomes equitably.