Évaluation de la mise en place d’un protocole de réhabilitation précoce postcésarienne

Cattin, A.; Baene, A. De; Achon, E.; Bersot, Y.; Destoop, Q.; Pélissier, A.; Bonneau, S.; Malinovsky, J.-M.; Graesslin, Olivier; Raimond, Émilie

doi:10.1016/j.gofs.2017.02.006

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…Many obstetric units in the UK have either introduced or are planning to introduce enhanced recovery (ER) as a means to reduce LoS after planned CS. The aim of ER is to optimize multiple aspects of patient care and improve recovery, thereby facilitating ED whilst maintaining quality of care and patient satisfaction [4,55]. The implementation of ER programs post planned CS results in multiple advantages: reduction of LoS, reduction of morbidity and earlier return home to normal life for women [4,55–57].…”

Section: Discussionmentioning

confidence: 99%

Length of stay following cesarean sections: A population based study in the Friuli Venezia Giulia region (North-Eastern Italy), 2005-2015

et al. 2019

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Background Births by cesarean section (CS) usually require longer recovery time, and as a result women remain hospitalized longer following CS than vaginal delivery (VD). A number of strategies have been proposed to reduce avoidable health care costs associated with childbirth. Among these, the containment of length of hospital stay (LoS) has been identified as an important quality indicator of obstetric care and performance efficiency of maternity centres. Since improvement of obstetric care at hospital level needs quantitative evidence, we compared the maternity services of an Italian region on LoS post CS. Methods We conducted a population-based study in Friuli Venezia Giulia (FVG), a region of North-Eastern Italy, collecting data from all its 12 maternity centres (coded from A to K) during 2005–2015. We fitted a multivariable logistic regression using LoS as a binary outcome, higher/lower than the international early discharge (ED) cutoffs for CS (4 days), controlling for hospitals as well as several factors related to the clinical conditions of the mothers and the newborn, the obstetric history and socio-demographic background. Results were expressed as adjusted odds ratios (aOR) with 95% confidence interval (95%CI). Population attributable risks (PARs) were also calculated as proportional variation of LoS>ED for each hospital in the ideal scenario of having the same performance as centre J (the reference) during calendar year 2015. Results were expressed as PAR with 95%CI. Differences in mean LoS were also investigated with a multivariable linear regression model including the same explanatory factors of the above multiple logistic regression. Results were expressed as adjusted regression coefficients (aRC) with 95%CI. Results Although decreasing over the years (5.0 ± 1.7 days in 2005 vs. 4.4 ± 1.7 days in 2015), the pooled mean LoS in the whole FVG during these 11 years was still 4.7 ± 1.7 days, higher than respective international ED benchmark. The significant decreasing trend of LoS>ED over time in FVG (aOR = 0.89; 95%CI: 0.88; 0.90) was marginal as compared to the variability of LoS>ED observed among the various maternity services. Regardless it was expressed as aRC or aOR, LoS after CS was lowest in hospital C, highest in hospital D and intermediate in centres I, K, G, F, A, H, E, B and J (in descending order). The aOR of LoS being longer than ED ranged from 1.63 (95%CI:1.46; 1.81) in hospital B up to 32.09 (95%CI: 25.68; 40.10) in facility D. When hospitals were ranked by PAR the same pattern was found, even if restricting the analysis to low risk pregnancies. Conclusions Although significantly decreasing over time, the mean LoS in FVG during 2005–2015 was 4.7 days, higher than the international threshold recommended for CS. There was substantial variability in LoS by facility centre, suggesting that internal organizational processes of single hospitals should be improved by enforcing standardized ...

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Section: Discussionmentioning

confidence: 99%

Length of stay following cesarean sections: A population based study in the Friuli Venezia Giulia region (North-Eastern Italy), 2005-2015

et al. 2019

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“…4 As in other surgical fields, elements of enhanced recovery have also been implemented after CS. [4][5][6][7][8][9] This concept aims to optimize perioperative care by a multimodal approach such as optimal analgesia, early mobilization, and early removal of drains. Enhanced recovery also aims to reduce the length of hospital stay (LOS), which might imply substantial healthcare savings.…”

Section: Introductionmentioning

confidence: 99%

Effect of early discharge after planned cesarean section on recovery and parental sense of security. A randomized clinical trial

Kruse

Lauszus

Forman

et al. 2020

Acta Obstet Gynecol Scand

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Introduction In some European countries, discharge the day after planned cesarean section has become an accepted procedure. However, little is known about the patients’ perception of early discharge. The aim of this study was to compare early discharge with standard care in relation to parental sense of security. Further, we evaluated postoperative pain, mobilization, and readmission. Material and methods We performed a randomized clinical trial including parous, singleton pregnant women with a planned cesarean section at term. The women were allocated to either discharge within 28 hours (intervention group) or after 48 hours (standard care group) following the cesarean section. Women discharged within 28 hours after cesarean section were offered a home visit by a midwife the following day. The primary outcome was the postnatal sense of security, which was reported by the woman and her partner in the “Parents’ Postnatal Sense of Security” questionnaire 1 week postpartum. Secondary outcomes were pain score, use of analgesics, mobilization, readmission, and contacts with the healthcare system in the postoperative period. Results We included 143 women, of whom 72 were allocated to the intervention group and 71 were allocated to the standard care group. There were no differences in baseline characteristics. The two groups did not differ concerning the postnatal sense of security for the women (P = .98) or the postnatal sense of security for the partners (P = .38). We found no difference in pain scores, step count, use of analgesics, or number of contacts with the health‐care system between the groups. Conclusions Parental postnatal sense of security is not compromised by discharge within 28 hours followed by a home visit compared with discharge after 48 hours after planned cesarean section among parous women.

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“…9,10 Components of published ERAS for cesarean delivery guidelines are evidence based; however, there is little available evidence regarding actual protocol implementation in an obstetric population. 5,6,[11][12][13] This gap includes a lack of data on protocol adherence (a hospital's ability to implement all components reliably), outcomes (including length of stay, urinary catheter removal, pain control, and patient-centered outcomes), and unintended adverse events (including readmission). ERAS protocols often include sweeping changes to patterns of postcesarean care.…”

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confidence: 99%

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

et al. 2020

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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

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Évaluation de la mise en place d’un protocole de réhabilitation précoce postcésarienne

Cited by 9 publications

References 18 publications

Length of stay following cesarean sections: A population based study in the Friuli Venezia Giulia region (North-Eastern Italy), 2005-2015

Length of stay following cesarean sections: A population based study in the Friuli Venezia Giulia region (North-Eastern Italy), 2005-2015

Effect of early discharge after planned cesarean section on recovery and parental sense of security. A randomized clinical trial

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

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