Highlights
- •Studies comparing enhanced recovery after caesarean delivery (ERAC) to control group.
- •11 peer-reviewed studies; 36 abstracts; 42 ERAC interventions; 90 outcomes reported.
- •GRADE level evidence was low or very low for all outcomes.
- •Most studies showed benefit and none harm, so ERAC adoption is recommended.
- •High-quality studies needed to gain consensus re optimum interventions and outcomes.
Abstract
Background
This systematic review aimed to determine whether enhanced recovery after caesarean
delivery (ERAC) protocols should be adopted.
Methods
We searched four databases and abstracts from meetings for studies comparing ERAC
to standard care. We report interventions, outcomes, qualitative impact of ERAC implementation
and use GRADE scoring to determine quality of evidence and make recommendations regarding
ERAC adoption, based on key outcomes (length of stay, financial savings, satisfaction,
re-admission, opioid usage, breastfeeding success and maternal-neonatal bonding).
Results
Eleven published studies and 36 abstracts evaluating ERAC were included. Forty-two
study interventions (40 in published studies) and 90 outcome measures (60 in published
studies) were used. Most studies showed a reduction in hospital stay (6/7 studies)
and reduced costs (2/2 studies) with ERAC compared with standard care. Satisfaction
was inconsistently reported. Re-admission rates were similar between groups. Two studies
showed a reduction and two showed no difference in opioid consumption with ERAC. One
study showed improvement and another showed no change in outpatient breastfeeding
rates with ERAC. One study showed better inpatient maternal-neonatal bonding. The
GRADE level of evidence was low or very low for all outcomes.
Conclusions
Studies evaluating ERAC used heterogeneous interventions and outcomes. Although there
is currently low- or very low-level evidence supporting all outcomes evaluated, the
majority of studies showed some benefits and none reported harm. On balance, we recommend
the use of ERAC. Future studies are needed to strengthen ERAC recommendations by standardising
interventions and reported outcomes.
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Article info
Publication history
Published online: March 26, 2020
Accepted:
March 20,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
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- Enhanced Recovery After Cesarean (ERAC) – beyond the pain scoresInternational Journal of Obstetric AnesthesiaVol. 43
- PreviewEnhanced recovery protocols aim to optimize patient outcomes by modifying the inflammatory and metabolic changes associated with surgery. Multimodal evidence-based interventions that may reduce the surgical stress response have been organized into a specific care pathway which can shorten the recovery period and reduce peri-operative complications.1 More than 20 years ago, Henrik Kehlet, a pioneer in peri-operative pathophysiology and rehabilitation, initiated the first enhanced recovery protocol for colorectal surgery.
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