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

Janu Kanthi Mangala; Chithra Remadevi; Pragalya Loganathan; Sandra R; Gopukrishnan; Anu Vasudevan

doi:10.1007/s13224-021-01461-6

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 Gynaecol India. 2021 Aug;71(Suppl 1):12-17. doi: 10.1007/s13224-021-01461-6. Epub 2021 Mar 30.

Authors

Janu Kanthi Mangala¹, Chithra Remadevi¹, Pragalya Loganathan¹, Sandra R¹, Gopukrishnan¹, Anu Vasudevan²

Affiliations

¹ Department of OBG, Amrita Institute of Medical Sciences, Amrita Viswavidyapeetham, Ponekkara, Kochi, Kerala 682041 India.
² Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Viswavidyapeetham, Ponekkara, Kochi, Kerala 682041 India.

Abstract

Objectives: To study the implementation of ERAS (Enhanced recovery after surgery) pathway and its effect on duration of post-operative hospital stay and various phases of post-operative care in comparison with conventional care group.

Materials and method: Prospective study conducted in Amrita institute of medical sciences, Kochi, Kerala. Women planned for elective and scheduled caesarean section were included in the study from September 2020 to October 2020 and compared with women who underwent caesarean section in the same period receiving standard perioperative care. Women who underwent emergency and urgent caesarean section and patients with medical or surgical comorbidities were excluded. Surgical procedure was the same in both arms. Intravenous hydration was goal directed. Oral feeding was started with liquids after 2 hours, solids were given after 4 hours. Intravenous paracetamol and diclofenac were given routinely. Intravenous tramadol and fentanyl were given if needed apart from these analgesics. Foleys catheter was removed after 12 hours. Conventional care group observed 6 h of fasting pre- and post-operatively. Catheter was retained for 24 h, 2500 ml IV fluids were infused on the first day followed by 1000 ml on the second day. The duration of hospital stay was based on clinical criteria and care providers decision.

Results: In ERAS arm, post-operative hospital stay was significantly reduced in comparison with conventional care group. (53.91 vs 77.71 h-p = 0.00) Early feeding, early ambulation, early catheter removal, multimodal and preemptive analgesia all contributed to early recovery of the patient.

Conclusion: In ERAS pathway length of post-operative stay was significantly reduced as compared to conventional care.

Supplementary information: The online version contains supplementary material available at 10.1007/s13224-021-01461-6.

Keywords: Analgesia; Caesarean section; Early ambulation; Enhanced recovery after surgery (ERAS); Length of hospital stay.