Comparison of post-operative outcomes between enhanced recovery after surgery versus standard operative protocol among cesarean delivery mothers at a tertiary hospital.
- Author:
Lourdes Therese S. Reyes
1
;
Charisse P. Guerrero
Author Information
- Publication Type:Journal Article
- Keywords: Enhanced Recovery After Surgery; ERAS protocol; Cesarean delivery
- MeSH: Cesarean Section
- From: Journal of the Philippine Medical Association 2021;100(1):29-50
- CountryPhilippines
- Language:English
- Abstract: This Randomized Controlled Trial sought to determine whether mothers who underwent Cesarean delivery had better postoperative outcomes when subjected to the Enhanced Recovery After Surgery (ERAS) protocol compared to mothers who also underwent Cesarean section as a mode of delivery but were under the Standard operative protocol. The research concentrated on evaluating the postoperative outcomes of the patients in the study through the following factors: length of hospitalization, efficiency and cost-effectiveness of hospital expenses, early resumption of diet and early ambulation, breastfeeding initiation and continuation. A total of 72 subjects were included in the study. Two were not included due to conversion to general anesthesia. Thirty two (44.4%) were randomized to the ERAS protocol while 40 (55.6%) patients were randomized to Standard postoperative procedure. Demographic characteristics were recorded and comparable between the two groups. Mothers randomized to the ERAS protocol had significantly shorter length of stay compared to mothers in the standard operative procedure with a mean of 53.01 hours (2.21 days) and 78.86 hours (3.29 days) respectively. Mothers randomized to the ERAS protocol spent significantly lower hospitalization cost compared to mothers in the standard operative procedure. There was no significant difference noted in the proportion of mothers with fever between the two groups (p=0.25). Mothers randomized to the ERAS protocol had significantly lower post-operative pain compared to mothers in the standard operative procedure. The time from end of OR until general liquids was also significantly shorter among mothers randomized to the ERAS protocol compared to mothers in the standard operative procedure. Similarly, the time from end of OR to flatus and bowel movement was also significantly shorter among mothers randomized to the ERAS protocol compared to mothers in the standard operative procedure. The time from end of OR to removal of foley catheter and time to void after foley catheter removal was also significantly shorter among mothers randomized to the ERAS protocol compared to mothers in the standard operative procedure. Finally, there was a significant difference noted in the length of time from end of OR to breastfeeding as proven by all p value of 0.02. Mothers randomized to the ERAS protocol had significantly shorter length of time from end of OR to breastfeeding compared to mothers in the standard operative procedure with a mean of 30.67 hours and 43.09 hours respectively. Ultimately, the study concentrated on Emergency or Elective Cesarean deliveries of Low risk patients as well as patients with controlled gestational or overt diabetes mellitus, thyroid disorders in euthyroid state, and hypertensive disorders not complicated with eclampsia. This study did not seek to generalize the benefit of ERAS protocol on all Cesarean deliveries. ERAS protocol showed better postoperative outcomes compared to the Standard operative protocol in terms of shorter length of hospital confinement, lower cost of hospitalization, no occurrence of post-operative infections and complications, shorter length of time from operation to diet progression tolerance, passage of flatus, bowel movement, shorter length of time from end of OR to removal of foley catheter and time to void and finally shorter time from operation to initiation of breastfeeding and continuation.
- Full text:Comparison_of_post-operative_outcomes.pdf
