Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Division of Research, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Am J Perinatol. 2021 Aug;38(S 01):e215-e223. doi: 10.1055/s-0040-1709456. Epub 2020 Jun 2.
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.
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.
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, < 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 > 0.05).
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.
· 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)..
本研究旨在评估住院医师主导的围手术期加速康复（ERAS）方案对计划性产前剖宫产患者住院时间和产后阿片类药物使用量的影响。
这项回顾性队列研究纳入了在一家学术性三级医疗机构实施 ERAS 方案前后行计划性产前剖宫产的患者。主要结局是剖宫产术后的住院时间。次要结局包括方案依从性、住院期间阿片类药物使用量和以患者为中心的结局。方案包括多模式镇痛和止吐药物、加速导尿管移除、早期停止维持静脉输液和早期活动。
共纳入 250 例患者：ERAS 方案实施前为 122 例，实施后为 128 例。两组患者的基线人口统计学、合并症或剖宫产特征无差异。实施方案后，患者的平均住院时间缩短了 7.9 小时（ERAS 方案前为 82.1 小时，ERAS 方案后为 74.2 小时， < 0.001）。方案的整体依从率为 89.8%。患者的阿片类药物用量平均减少了 36.5mg 羟考酮/人，但术后第 1 天至第 4 天的疼痛评分无显著差异（所有 > 0.05）。
住院医师主导的质量改进项目与住院时间缩短、阿片类药物使用量减少以及出院时视觉模拟疼痛评分不变有关。该 ERAS 方案的实施是可行且有效的。
·加速康复（ERAS）原则可有效地应用于剖宫产，且方案依从性良好。·参与 ERAS 方案的患者，其住院时间和阿片类药物用量显著减少，而术后第 1 天至第 4 天的视觉模拟疼痛评分无变化。·住院医师主导的质量改进项目对过程指标（如方案依从性）和结果指标（如阿片类药物使用量）都能产生重大影响。
