Impact of enhanced recovery after cesarean protocol on postoperative urinary retention

Postoperative urinary retention (POUR) remains a common concern associated with cesarean delivery (CD). Recently, efforts have been made to expedite recovery after CD through Enhanced Recovery After Cesarean (ERAC) pathways. We aimed to evaluate whether the implementation of an ERAC protocol impacts the incidence of POUR after CD.

This is a secondary analysis of a prospective, longitudinal, quality improvement (QI) study of patients undergoing CD before and after implementation of an ERAC protocol. CD patients requiring general anesthesia, significantly complicated CD, and patients with chronic pain disorders were excluded. The primary outcome was POUR, defined as failure of spontaneous voiding 6 hours (h) after Foley catheter removal. Secondary outcomes were the duration of Foley catheter placement and replacement of Foley catheter.

Three hundred-eight patients were included. The incidence of POUR was similar between groups pre-ERAC (44, 22.6%) vs post-ERAC (36, 31.8%), p = 0.08. Time to Foley removal following CD was significantly decreased in the post-ERAC cohort [10.1 h (7.2, 13.7) vs. 12.5 h (10.9, 17.8)] (p < 0.001). Need for Foley catheter replacement occurred at a similar rate (pre-ERAC: 1.0%; post-ERAC: 0.9%, p = 0.7).

There was no significant difference in POUR after implementing an ERAC protocol, although a trend toward increased incidence was noted. Post-ERAC implementation resulted in a significant decrease in the duration of Foley catheter placement.