Enhanced Recovery after Elective Cesarean Delivery at Ain Shams University Maternity Hospital: A Randomized Controlled Trial

Abstract Background Enhanced recovery after cesarean delivery (ERAC) is perioperative care program to fasten patients recovery. ERAC protocols intended to improve patient outcomes and fasten return to normal function before surgery by standardization of practice at all stages: preoperative, intraoperative and postoperative. Aim of the Study The aim of this study was to evaluate whether the implementation of enhanced recovery after cesarean (ERAC) would decrease the length of hospital stay and pain score and improve postoperative patient satisfaction and breastfeeding and its effect on postoperative complications and hospital readmission. Patients and Methods 86 pregnant women undergoing uncomplicated elective cesarean delivery were enrolled in this study. patients were randomized to two groups: 43 patients in the Enhanced recovery after cesarean delivery (ERAC) group and 43 patients in the standard care group. Enhanced recovery after cesarean involved multiple evidence-based interventions and were divided into the three major phases of patient care: antepartum, intrapartum and postpartum. The primary outcome was the length of hospital stay after cesarean delivery. Secondary outcomes included pain medication requirements and pain scores, breastfeeding and first time of start breastfeeding, maternal satisfaction, postoperative complications and hospital readmission. Results Enhanced recovery after cesarean delivery was associated with a highly significantly shorter length of hospital stay when compared to standard care (p- value <0.001). There was a highly significant reduction in pain scores at 2h, 4h, 6h and 12h in the ERAC group in comparison to standard care group (p-value <0.001). There was no statistically significant difference between the two groups of studied participants regarding breastfeeding (p-value=0.5). However, there was statistically highly significant difference between the two groups of studied participants regarding the time of starting breastfeeding (p-value <0.001). The participants were more significantly satisfied in the ERAC group than in the standard group (p-value>0.001). Conclusion Implementation of enhanced recovery after elective cesarean delivery (ERAC) pathway lead to significantly shorter length of hospital stay, lower pain scores, better patient satisfaction and earlier start of breastfeeding.