Enhanced Recovery Pathway as a Tool in Reducing Post-operative Hospital Stay After Caesarean Section, Compared to Conventional Care in COVID Era-A Pilot Study

Mangala, Janu Kanthi; Remadevi, Chithra; Loganathan, Pragalya; Sandra, Rhona; Gopukrishnan,; Vasudevan, Anu

doi:10.1007/s13224-021-01461-6

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…6 A similar study conducted in Kerala in 2020 by Mangala and associates showed a much lesser LOS than this study which was 2.2 days. 13 In Thailand, in a similar study by Chantarasorn et al, the overall duration of the hospital stay was 3.3 days which is comparable to the present study. 19 An early discharge from the hospital is one of the hallmarks of ERAS pathway adoption.…”

Section: Discussionsupporting

confidence: 90%

“…In the pilot study conducted in Kerala by Mangala et al, the duration for ambulation in the ERAS group was 17.3 ± 4.47 hours after surgery as the catheter was removed 12 hours after surgery. 13 In this study, early removal of Foleys catheter aided in lesser duration to the first ambulation as compared to the other studies. Basbug et al opined that early removal of urinary catheters after cesarean delivery is associated with reduced mobilization time and hospital stay with no significant differences in terms of bacteriuria, urinary retention, dysuria, and first postoperative voiding, 14 which showed similar results in this study.…”

Section: Discussionmentioning

confidence: 64%

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Enhanced Recovery after Surgery Protocol Implementation on Elective Cesarean Delivery: A Cross-sectional Study

Narkhede¹,

Vipulachandra²,

Bhanap³

et al. 2023

Journal of South Asian Federation of Obstetrics and Gynaecology

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Aim and objective: To estimate the outcomes of enhanced recovery after surgery (ERAS) protocol implementation in perioperative elective cesarean patients. Study design: Cross-sectional study was conducted from January 2020 to December 2021 at a tertiary healthcare center. During the study period, ERAS protocol was implemented on elective cesarean deliveries at the study institution to find out the time to first ambulate, incidence of urinary retention, total intravenous (IV) fluids in the postoperative period, tolerability of early oral intake, hospital stay, readmissions for maternal cause, and the complications up to 30 days postpartum. Results: In total, 150 cases were enrolled in the study. Six hours 23 minutes was the mean ambulation time, and all patients started ambulation within 10 hours of surgery. There were no cases of urinary retention. About 132 patients needed 1500 mL of IV fluids in the postopertive period. About 146 postoperative patients tolerated a 2-hour liquid diet. The postoperative length of stay was 3 days 3 hours with 11 cases of postoperative complications with 3 cases requiring readmission. Conclusion:The implementation of ERAS protocols in elective cesarean delivery has shown favorable outcomes with minimal complications and readmission. Early resumption of oral feed was well-tolerated and led to a reduced need for IV fluids. Early removal of the catheter aided in early ambulation and without undue retention of urine. Early discharge is beneficial for the patient to reduce hospital-acquired infections and bed turnover in limited-bedded hospitals. Enhanced recovery after surgery protocol can be implemented in low-risk elective cases posted for cesarean delivery in Government hospitals.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 64%

Enhanced Recovery after Surgery Protocol Implementation on Elective Cesarean Delivery: A Cross-sectional Study

Narkhede¹,

Vipulachandra²,

Bhanap³

et al. 2023

Journal of South Asian Federation of Obstetrics and Gynaecology

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Impact of enhanced recovery after surgery (ERAS) guidelines implementation in cesarean delivery: A systematic review and meta-analysis

Pinho,

Costa

2024

European Journal of Obstetrics & Gynecology and Reproductiv

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Enhanced recovery after cesarean (ERAC) versus conventional care: An expanded systematic review and meta-analysis of 18,368 subjects

Lestari,

Sari,

Chandra

et al. 2024

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: Enhanced recovery after cesarean (ERAC) is an interdisciplinary approach to improve patient outcomes following cesarean section. ERAC’s execution must be constantly evaluated. Thus, we aimed to analyze parameters associated with ERAC adoption for clinical care in this expanded systematic review. Material and Methods: A systematic literature search using Epistemonikos, Google Scholar, PubMed, and Scopus was done until February 2023. The appropriate observational and experimental research comparing the effects of ERAC protocols with conventional care on postoperative adverse events, operation-related characteristics, time to first (oral intake, mobilization, bowel movement, and urinary catheter removal), and opioid use. Meta-analyses were conducted using the RevMan 5.4.1. and Comprehensive Meta-Analysis version 3.3 software. Results: In total, 23 studies were included in this systematic review. ERAC implementation was found to be associated with improvement in terms of shorter postoperative hospital stays and faster time to first liquid intake, first solid diet, urinary catheter removal, and mobilization. Furthermore, the rate of opioid-free treatment, total in-hospital morphine milligram equivalent (MME), daily in-hospital MME, and total prescribed opioid pills at discharge (all parameters, P < 0.01) were significantly better in the ERAC group than in the conventional care group. However, no significant difference was observed regarding postoperative adverse events, blood loss, operation duration, and total prescribed MME at discharge parameters between the two observed groups. Conclusion: ERAC implementation is associated with better healthcare delivery, as determined by shorter time to first, lower opioid consumption, and shorter postoperative length of stay compared with conventional care. However, it is not associated with a lower dosage of opioid prescription at discharge. Key Message: ERAC has demonstrated immense advantages and appears to be the future of cesarean delivery methods worldwide. However, based on our analysis, it is not associated with a lower dosage of opioid prescription at discharge.

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Enhanced Recovery Pathway as a Tool in Reducing Post-operative Hospital Stay After Caesarean Section, Compared to Conventional Care in COVID Era-A Pilot Study

Cited by 3 publications

References 10 publications

Enhanced Recovery after Surgery Protocol Implementation on Elective Cesarean Delivery: A Cross-sectional Study

Enhanced Recovery after Surgery Protocol Implementation on Elective Cesarean Delivery: A Cross-sectional Study

Impact of enhanced recovery after surgery (ERAS) guidelines implementation in cesarean delivery: A systematic review and meta-analysis

Enhanced recovery after cesarean (ERAC) versus conventional care: An expanded systematic review and meta-analysis of 18,368 subjects

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