Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3)

Macones, George A.; Caughey, Aaron B.; Wood, Stephen L.; Wrench, I.; Huang, Jeffrey; Norman, Mikael; Pettersson, Karin; Fawcett, William; Shalabi, Medhat M.; Metcalfe, Amy; Gramlich, Leah; Nelson, Gregg; Wilson, R. Douglas

doi:10.1016/j.ajog.2019.04.012

Cited by 227 publications

(181 citation statements)

References 65 publications

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“…However, a methodical survey of PubMed, OvidSP, Google Scholar, and Scopus recognized just a single past examination of its impacts on gastrointestinal behaviour in patients after cesarean section [19]. Unfortunately, this study was not within Enhanced Recovery After Surgery (ERAS) Guidelines according to which early feeding is essential for patients undergoing surgery [20].…”

Section: Introductionmentioning

confidence: 96%

Can coffee consumption be used to accelerate the recovery of bowel function after cesarean section? Randomized prospective trial

et al. 2020

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Objectives: To evaluate whether coffee consumption accelerates the recovery of bowel function after cesarean section or not. Material and methods: This study was designed as randomized controlled study. Patients were randomly assigned to one of two groups: Ultimately, Group 1 (n = 51) was the study group and drank three cups of coffee after cesarean, whereas group 2 (n = 52) was not given any treatment. The primary outcome measure was the time to first defecation after surgery, the secondary outcomes were time to first bowel movement, passage of flatus, time to toleration of a solid diet, additional antiemetic and analgesic requirement. Results: There were no significant differences in demographic variables between the groups. The mean time to passage of first flatus was significantly shorter in the study group than the control group (8.6 ± 3.3 h vs 11.3 ± 7.5 h, respectively; p = 0.022). First defecation was 20.7 ± 11.5 h for the study group and at 29.1 ± 14.3 h for the control group (p = 0.001). In addition, there was a significant difference in mean time to toleration of solid food between the study and control groups (8.78 ± 2.33 h vs 12.88 ± 4.2.60 h, respectively; p < 0.001). Conclusions: Coffee can be used in patients to enhance the recovery of gastrointestinal function after elective cesarean section.

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Section: Introductionmentioning

confidence: 96%

Can coffee consumption be used to accelerate the recovery of bowel function after cesarean section? Randomized prospective trial

et al. 2020

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“…Enhanced recovery after surgery (ERAS) is a philosophy of perioperative care that has been utilized in other fields since the 1990s, yet only recently has been applied to obstetric care. [1][2][3][4][5][6][7] In various subspecialties, ERAS protocols have been shown to achieve the triple aim: increasing patient satisfaction, decreasing cost, and improving quality. 8 As key maternity care stakeholders seek to improve care quality and costs, ERAS may be a promising solution for addressing value in the postpartum period.…”

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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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“…The ERAS IG for CD provide speci c recommendations for post-operative CD care, including nausea and pain control, urinary catheter removal, and mobilization (16). Post-surgery, pain was well managed and medication provision was effectively communicated by the nursing staff.…”

Section: Post CDmentioning

confidence: 99%

“…The ERAS IG for CD recommends immediate removal of urinary catheter after CD to prevent infection and increase mobility (16); however, eleven of the twelve women did not have the catheter removed immediately after surgery. When timing was offered, removal occurred greater than 12 hours later, in the range of 12-36 hours post-CD.…”

Section: Post CDmentioning

confidence: 99%

“…Some women indicated they were instructed not to eat after their CD, while others described food not being available outside of the hospital's meal times. In all, eight of the women did not eat a regular diet within two hours of the procedure as recommended by the ERAS IG for CD (16). When offered, women indicated they had fasted between a total of 18-30 hours.…”

Section: Post CDmentioning

confidence: 99%

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Maternal Perceptions of Cesarean Delivery Care: A Qualitative Study to inform ERAS Guideline Development

Wollny¹,

Metcalfe²,

Corrigan³

et al. 2019

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INTRODUCTION: Cesarean delivery (CD) is the most common inpatient surgical procedure; however, there are no internationally-accepted, standardized clinical guidelines. The Enhanced Recovery After Surgery (ERAS®) program aims to improve outcomes through the development of international guidelines (IG). The purpose of this study is to obtain and consolidate women’s experiences with CD to inform the development of an ERAS international guideline (IG). METHODS: Qualitative methods were used to assess the patient experience with current evidence-based CD protocols across operative phases. Twelve women who experienced CD were interviewed using an open-ended, semi-structured interview guide at six-weeks post-partum. Two researchers coded the emerging themes separately and compared findings. RESULTS: Women described feeling informed, but felt they did not have a choice. Pre-surgery, women wanted more information about the risks of CD. Pre-operatively, women expressed confusion with the procedures, but felt informed about local anaesthesia and thermoregulation. Post-CD, women felt informed about pain and nausea control; however, urinary catheter removal was delayed when compared to the ERAS recommendations. Information about post-partum infant care was not well communicated, as many women were uninformed about delayed cord-clamping and infant thermoregulation. DISCUSSION: This qualitative study provides opportunities to improve communication, the patient-provider relationship, and the overall satisfaction throughout the CD process. The findings support the implementation of patient decision aids and training with the shared decision model. The improved procedures recommended in the ERAS IG for CD have the potential to deliver significant improvements to patient satisfaction, mother-infant bonding and mental wellness.

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Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3)

Cited by 227 publications

References 65 publications

Can coffee consumption be used to accelerate the recovery of bowel function after cesarean section? Randomized prospective trial

Can coffee consumption be used to accelerate the recovery of bowel function after cesarean section? Randomized prospective trial

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

Maternal Perceptions of Cesarean Delivery Care: A Qualitative Study to inform ERAS Guideline Development

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