Enhanced Recovery After Surgery for Cesarean Delivery Clinical Practice Guideline: Postoperative Interventions

Abstract

Problem & Purpose: In the United States, the cesarean delivery rate is approximately 32% of all births, with well over a million performed each year. Compared to women who performs spontaneous vaginal births, cesarean deliveries are associated with a prolonged length of stay. These women are usually young and healthy, possess the ability to achieve a rapid recovery, and have a unique incentive to return to their baseline functional capacity in order to care for their newborn. Enhanced Recovery After Surgery (ERAS) is a standardized set of perioperative interventions implemented to improve surgical outcomes, optimize patient care, and reduce hospital costs. Even though there is an enormous amount of evidence to support the improvements ERAS has made for perioperative care pathways among many surgical specialties, obstetrical surgery lacks established protocols based on such principles. The purpose of implementing the ERAS clinical practice guideline (CPG) is to standardize care throughout the perioperative period and optimize recovery for parturients undergoing elective cesarean deliveries. Methods: The CPG was created using high quality evidence and subsequently evaluated by elected stakeholders using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Dissemination took place following the incorporation of stakeholder recommendations and feedback. A Practitioner Feedback Questionnaire (PFQ) survey following the formal presentation or the CPG during grand rounds was given to anesthesia staff to assess acceptability and usability of the CPG. Results: Feedback received from the AGREE II Tool and PFQ show satisfactory results on the quality, usability, applicability, and acceptance of the CPG. Conclusion: The favorable AGREE II Tool assessment results, widespread acceptance of the interventions among staff as evidenced by the PFQ results, as well as the strength of evidenced utilized to create the recommendations included in the CPG, will facilitate the quality and safety of recovery for elective cesarean deliveries at the institution of interest.