Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 14 , ISSUE 6 ( November-December, 2022 ) > List of Articles

Original Article

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

Y Vipulachandra, Hemraj Narkhede, Prasad Laxmikant Bhanap, Anand Karale

Keywords : Ambulation, Cross-sectional study, Cesarean delivery, Enhanced recovery after surgery

Citation Information : Vipulachandra Y, Narkhede H, Bhanap PL, Karale A. Enhanced Recovery after Surgery Protocol Implementation on Elective Cesarean Delivery: A Cross-sectional Study. J South Asian Feder Obs Gynae 2022; 14 (6):667-671.

DOI: 10.5005/jp-journals-10006-2152

License: CC BY-NC 4.0

Published Online: 31-01-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

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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  1. Steenhagen E. Enhanced recovery after surgery: It's time to change practice. Nutr Clin Pract 2016;31(1):18–29. DOI: 10.1177/ 0884533615622640.
  2. Elias KM. Understanding enhanced recovery after surgery guidelines: An introductory approach. J Laparoendosc Adv Surg Tech A 2017;27(9):871–875. DOI: 10.1089/lap.2017.0342.
  3. Wilson RD, Caughey AB, Wood SL, et al. Guidelines for antenatal and preoperative care in cesarean delivery: Enhanced Recovery After Surgery Society recommendations (Part 1). Am J Obstet Gynecol 2018;219(6):523.e1–523.e15. DOI: 10.1016/j.ajog.2018.09.015.
  4. Caughey AB, Wood SL, Macones GA, et al. Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society recommendations (Part 2). Am J Obstet Gynecol 2018;219(6):533–544. DOI: 10.1016/j.ajog.2018.08.006.
  5. Macones GA, Caughey AB, Wood SL, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). Am J Obstet Gynecol 2019;221(3):247.e1–247.e9. DOI: 10.1016/j.ajog.2019.04.012.
  6. Kleiman AM, Chisholm CA, Dixon AJ, et al. Evaluation of the impact of enhanced recovery after surgery protocol implementation on maternal outcomes following elective cesarean delivery. Int J Obstet Anesth 2020;43:39–46. DOI: 10.1016/j.ijoa.2019.08.004.
  7. Bisch SP, Wells T, Gramlich L, et al. Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes. Gynecol Oncol 2018;151(1):117–123. DOI: 10.1016/j.ygyno.2018.08.007.
  8. Fay EE, Hitti JE, Delgado CM, et al. An enhanced recovery after surgery pathway for cesarean delivery decreases hospital stay and cost. Am J Obstet Gynecol 2019;221(4):349.e1–349.e9. DOI: 10.1016/j.ajog.2019.06.041.
  9. Huang J, Cao C, Nelson G, et al. A review of enhanced recovery after surgery principles used for scheduled caesarean delivery. J Obstet Gynaecol Can 2019;41(12):1775–1788. DOI: 10.1016/j.jogc.2018.05.043.
  10. Rogers DM. Enhanced Recovery After Surgery (ERAS) Programs for cesarean delivery can potentially reduce healthcare and racial disparities. J Natl Med Assoc 2019;111:464. DOI: 10.1016/j.jnma. 2019.02.001
  11. Bhatia M, Banerjee K, Dixit P, et al. Assessment of variation in cesarean delivery rates between public and private health facilities in India from 2005 to 2016. JAMA Netw Open 2020;3(8):e2015022. DOI: 10.1001/jamanetworkopen.2020.15022.
  12. Liang CC, Chang SD, Chang YL, et al. Postpartum urinary retention after cesarean delivery. Int J Gynecol Obstet 2007;99(3):229–232. DOI: 10.1016/j.ijgo.2007.05.037.
  13. Mangala JK, Remadevi C, Loganathan P, et al. 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. J Obstet Gynecol India 2021;71(Suppl 1):12–17. DOI: 10.1007/s13224-021-01461-6.
  14. Basbug A, Yuksel A, Ellibeş Kaya A. Early versus delayed removal of indwelling catheters in patients after elective cesarean section: A prospective randomized trial. J Matern Fetal Neonatal Med 2020;33(1):68–72. DOI: 10.1080/14767058.2018.1487394.
  15. Tamang T, Wangchuk T, Zangmo C, et al. The successful implementation of the Enhanced Recovery After Surgery (ERAS) program among caesarean deliveries in Bhutan to reduce the postoperative length of hospital stay. BMC Pregnancy Childbirth 2021;21(1):637. DOI: 10.1186/s12884-021-04105-9.
  16. Pan J, Hei Z, Li L, et al. The advantage of implementation of Enhanced Recovery After Surgery (ERAS) in acute pain management during elective cesarean delivery: A prospective randomized controlled trial. Ther Clin Risk Manag 2020;16:369–378. DOI: 10.2147/TCRM.S244039.
  17. Ogbadua AO, Agida TE, Akaba GO, et al. Early versus delayed oral feeding after uncomplicated cesarean section under spinal anesthesia: A randomized controlled trial. Niger J Surg 2018;24(1):6–11. DOI: 10.4103/njs.NJS_26_17.
  18. Martin EK, Beckmann MM, Barnsbee LN, et al. Best practice perioperative strategies and surgical techniques for preventing caesarean section surgical site infections: A systematic review of reviews and meta-analyses. BJOG 2018;125(8):956–964. DOI: 10.1111/ 1471-0528.15125.
  19. Chantarasorn V, Tannirandorn Y. A comparative study of early postoperative feeding versus conventional feeding for patients undergoing cesarean section: A randomized controlled trial. J Med Assoc Thai 2006;89(Suppl 4):S11–S16. PMID: 17725138.
  20. Wrench IJ, Allison A, Galimberti A, et al. Introduction of enhanced recovery for elective caesarean section enabling next day discharge: A tertiary centre experience. Int J Obstet Anesth 2015;25(2):124–130: DOI: 10.1016/j.ijoa.2015.01.003.
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