Post-operative outcomes of enhanced recovery versus conventional approach in elective caesarean section: a prospective comparative study

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Background: Caesarean section (CS) is one of the most common obstetric procedures in the world. The traditional post-operative management is known to lead to delayed recovery, extended hospital stays and maternal discomfort. Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative, evidence-based approach. The objectives of this study were to compare the outcomes of ERAS with standard care for women who undergo elective caesarean section, with emphasis on bowel and bladder recovery, mobility and self-care, and hospital stay. Methods: A prospective comparative study with 118 women who underwent elective CS was conducted, with 59 women in each group (ERAS and conventional). The groups were comparable with regard to baseline sociodemographic, obstetric, and laboratory parameters. Assessment of outcomes included time to first flatus, bowel movement, spontaneous voiding, ambulation, self-care ability, postoperative complications, duration of intravenous fluid therapy, removal of the catheter, hospital stay, and patient satisfaction. A p value of <0.05 was considered statistically significant. Results: ERAS group had significantly earlier recovery of bowel and bladder function, earlier ambulation and more independence in self-care than the conventional care group (p<0.001). The ERAS group had a significantly shorter mean hospital stay (3.5±1.6 vs. 5.2±3.1 days, p=0.04), and more early discharges. ERAS participants had fewer postoperative complications, such as puerperal fever, paralytic ileus and wound infection. The patient satisfaction scores were also significantly higher in the ERAS group (p<0.001). Conclusions: ERAS protocols have positive effects on postoperative recovery, hospital stay and morbidity following elective CS and should be routinely used in obstetric practice.

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