Professional society recommended interventions for enhanced recovery after cesarean delivery in the United States: a...

Existing enhanced recovery after cesarean delivery (ERAC) professional society recommendations lack intersociety collaboration, endorsement from relevant US professional societies, and inclusion of patient stakeholders.This initiative aimed to formulate a multidisciplinary set of ERAC interventions supported/endorsed or developed with input from relevant US professional societies, the Enhanced Recovery After Surgery (ERAS) Society and patient representatives.

This initiative received IRB approval from Stanford University. In total 19 stakeholders were invited to participate in this Delphi study, including 12 from seven US professional societies (American Society of Anesthesiologists (ASA - 1 stakeholder), Society for Obstetric Anesthesia and Perinatology (SOAP - 2), American College of Obstetricians and Gynecologists (ACOG - 4), Society for Maternal Fetal Medicine (SMFM - 1), Society of OBGYN Hospitalists (SOGH - 1), Association of Women's Health Obstetric and Neonatal Nurses ((AWHONN -2), American Association of Nurse Anesthesiology (AANA - 1), a representative from the ERAS Society, a physical therapist, a lactation expert and 4 patient representatives from diverse backgrounds. A three-roundmodified Delphi approach was conducted (two rounds of electronic questionnaires and a third round of e-discussion), to produce the final set of ERAC recommendations. An initial list of 70 interventions was compiled based on a previously published systematic reviewof ERAC studiesand professional society guidelines/recommendations (ERAS Society, SOAP, and Healthcare Canada). Consensus was obtained for the final list of interventions, with strong consensus defined as ≥70 % agreement and weak consensus as 50-69 % agreement.

Content-expert stakeholders were included from seven major US professional obstetric, anesthesia and nursing societies, the ERAS Society and physical therapy, lactation consultant and patient representatives also participated. All 19 stakeholders completed each round of the Delphi process. A final set of 32 interventions (six preoperative, 13 intraoperative and 13 postoperative) achieved strong consensus.

This multidisciplinary Delphi study resulted in 32 ERAC interventions, which were supported/endorsed or developed with input from seven US professional societies, the ERAS Society and physical therapy, lactation consultant and patient representatives. These interventions should be considered for patients undergoing scheduled cesarean delivery in the US. Future initiatives are needed to formulate recommendations for non-US and lower resource settings.