Enhanced Recovery after Surgery for Cesarean Delivery Decreases Length of Hospital Stay and Opioid Consumption: A Quality Improvement Initiative

Abstract

Objective The aim of this study is to assess the effect of a resident-led enhanced recovery after surgery (ERAS) protocol for scheduled prelabor cesarean deliveries on hospital length of stay and postpartum opioid consumption. Study Design This retrospective cohort study included patients who underwent scheduled prelabor cesarean deliveries before and after implementation of an ERAS protocol at a single academic tertiary care institution. The primary outcome was length of stay following cesarean delivery. Secondary outcomes included protocol adherence, inpatient opioid consumption, and patient-centered outcomes. The protocol included multimodal analgesia and antiemetic medications, expedited urinary catheter removal, early discontinuation of maintenance intravenous fluids, and early ambulation. Results A total of 250 patients were included in the study: 122 in the pre-ERAS cohort and 128 in the post-ERAS cohort. There were no differences in baseline demographics, medical comorbidities, or cesarean delivery characteristics between the two groups. Following protocol implementation, hospital length of stay decreased by an average of 7.9 hours (pre-ERAS 82.1 vs. post-ERAS 74.2, p < 0.001). There was 89.8% adherence to the entire protocol as written. Opioid consumption decreased by an average of 36.5 mg of oxycodone per patient, with no significant differences in pain scores from postoperative day 1 to postoperative day 4 (all p > 0.05). Conclusion A resident-driven quality improvement project was associated with decreased length of hospital stay, decreased opioid consumption, and unchanged visual analog pain scores at the time of hospital discharge. Implementation of this ERAS protocol is feasible and effective. Key Points

The successful implementation of the ERAS program among Caesarean deliveries to reduce the postoperative length of hospital stay

“…The ndings of shorter length were consistent with the study done by Mullman et al, who was able to demonstrate a reduction of LOS by 0.8 days (13). Due to shorter stay, a decrease in the hospital associated costs has been observed along with the reduction in administration of opioids in the postoperative period (2,14).This implicates a reduction in expenditure for free healthcare like ours in Bhutan where the sole funding comes from the state.…”

Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis

“…Consistent with prior studies examining the effects of ERAS pathways, our study found a variety of benefits associated with the implementation of pain management guidelines at our institution for patients undergoing cesarean delivery (Shinnick et al 2020 ). These benefits included an increase in the adoption of inpatient multimodal analgesia and a reduction in inpatient opioid consumption.…”

The Clinical Efficacy and Safety of Enhanced Recovery After Surgery for Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies

“…Subsequently, the remaining 12 full-text articles were assessed for eligibility, and two were excluded for unextractable useful outcomes data. Finally, 10 studies were included in the meta-analysis (16)(17)(18)(19)(25)(26)(27)(28)(29)(30). The selection process is presented in Figure 1.…”