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Enhanced recovery after surgery at cesarean delivery to reduce postoperative length of stay: a randomized controlled trial.
What is already known:
There have been a number of different studies on ERAS pathways for elective caesarean section, but currently none have been RCTs. Guidelines have even been produced by the ERAS society (found here).
What this paper adds:
This is a US study and the first RCT conducted, where patients were randomised by concealed envelope to either an ERAS protocol or standard care. It was a small, single centre study with only 121 patients. Their primary outcome was what they described as “early discharge” on post-operative day two. [I’m going to add a personal note here and say my wife who didn’t follow an ERAS pathway after her elective section went home on POD 1 both times!]. Only 8.6% of patients in the ERAS group were discharged on day 2, compared to 3.3% in the standard group (p=0.24). However when they compared the length of stay measured in hours they did find it was significantly shorter in the ERAS group. However, whilst 73.5 vs 75.5 hours was statistically significant (p=0.046), I’m not sure we can say it was particularly clinically significant. There was also no difference in postoperative morphine usage. There were a number of limitations to this study. Small patient numbers, single centre with possible cross over of patients in the post-op wards receiving the same ERAS type instructions.
Chris Jones, Guildford. @chrisnjones
A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda. Baluku M et al A Randomized Controlled…
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