Implementing a bundle for evidence-based cesarean delivery may not be as beneficial as expected: a multicenter, pre-...

Area of Science:

• Obstetrics and Gynecology
• Surgical Quality Improvement
• Implementation Science

Background:

• Standardization of surgical procedures can enhance patient outcomes.
• Systematic reviews have identified evidence-based steps for cesarean delivery, but their bundled implementation has not been studied.

Purpose of the Study:

• To evaluate the impact of implementing bundled evidence-based steps for cesarean delivery compared to surgeon preference on maternal and neonatal outcomes.

Main Methods:

• A multicenter preimplementation and postimplementation trial was conducted across four teaching hospitals.
• Maternal and neonatal composite morbidities were primary and secondary outcomes, respectively.
• Bayesian logistic regression was used to analyze outcomes, with a priori sample size calculations.

Main Results:

• The adherence to evidence-based steps increased from 79% to 89% post-implementation.
• Composite maternal morbidity showed a modest reduction (26% to 22%), with a 94% probability of improvement.
• Composite neonatal morbidity showed a paradoxical increase (37% to 41%), with a 95% probability of worsening.

Conclusions:

• Bundling evidence-based steps for cesarean delivery led to a slight decrease in maternal morbidity but an concerning rise in neonatal morbidity.
• While individual evidence-based steps may be beneficial, the formal bundling of these steps is not recommended at this time.