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Am J Perinatol 2021; 38(S 01): e215-e223
DOI: 10.1055/s-0040-1709456
Original Article

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

Julia K. Shinnick
1   Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Merima Ruhotina
1   Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Phinnara Has
2   Division of Research, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Bridget J. Kelly
1   Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
E. Christine Brousseau
1   Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
James O'Brien
1   Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Alex Friedman Peahl
3   National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan
4   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
› Author Affiliations Funding None.
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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

  • Enhanced recovery after surgery (ERAS) principles can be effectively applied to cesarean delivery with excellent protocol adherence.

  • Patients who participated in the ERAS pathway had significant decreases in hospital length of stay and opioid pain medication consumption with unchanged visual analog pain scores postoperative days 1 through 4.

  • Resident-driven quality improvement projects can make a substantial impact in patient care for both process measures (e.g., protocol adherence) and outcome measures (e.g., opioid use).

Keywords

enhanced recovery after surgery - cesarean delivery - opioid medications - length of hospital stay

Supplementary Material



Publication History

Received: 13 December 2019

Accepted: 02 March 2020

Article published online:
02 June 2020

© 2020. Thieme. All rights reserved.

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