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Barriers to Discharge Following Scheduled Cesarean Delivery: Is Obstetrics Ready for Enhanced Recovery After Surgery?
Abstract Number: F-27
Abstract Type: Original Research
As enhanced recovery after surgery (ERAS) programs increase in popularity and show improved outcomes for colorectal and other abdominal surgeries, institutions are expanding these evidence based practices to other surgical fields, optimizing post-operative pain control, length of hospital stay, return of bowel function and patient satisfaction. Given that cesarean delivery (CD) remains one of the most common surgical procedures in the United States, the implementation of ERAS protocols in this population could have a significant impact on healthcare resource utilization by improving patient outcomes and minimizing length of stay. The goal of this study was to demonstrate a need for an ERAS protocol for scheduled CD and to identify factors that could be barriers to discharge following CD.
After Institutional Review Board (IRB) approval, a chart review was conducted for scheduled CDs from November 2014 through November 2015 at the University of North Carolina Hospitals in Chapel Hill, North Carolina. Patient demographic data was evaluated to identify any apparent associations with length of stay. In addition, the most recent 38 patients were surveyed by telephone and asked if they preferred an earlier discharge, and what major factor they believed played a role in lengthening their hospital stay.
Of 328 cesarean sections, the mean length of stay was 3.1 days with a mean patient age of 31.9 years and body mass index (BMI) of 31.5. Increased parity and lower ASA scores were associated with decreased length of stay. BMI, age, race, surgical time, surgery day of the week and type of neuraxial anesthetic were not statistically significant with the corresponding length of stay, similar to the findings presented in an ERAS study by Wrench et al. In our telephone survey, 14/38 (36.7%) of the patients said they would have preferred to be discharged home one day earlier. More importantly, 17.1% of patients were discharged on POD 2, demonstrating the feasibility of early discharge. 26.7% of patients were discharged on POD 4, suggesting that a significant number of patients could reduce their length of stay. Barriers to discharge reported by survey participants included pain (39%), latching (21%), no issues (16%), problem with infant (13%), and other (11%). In the next phase of our project, we plan to address some of the issues identified in our survey by implementing a multi-disciplinary ERAS protocol that combines evidence-based standards of care for perioperative management to improve readiness for discharge after CD.
1. Wrench, I. J., et al. "Introduction of enhanced recovery for elective caesarean section enabling next day discharge: a tertiary centre experience." Int Journal of Obst Anesthesia 24.2 (2015): 124-130.
2. Tan, P.C., et al. "Hospital discharge on the first compared with the second day after a planned CD: a randomized controlled trial." Obst & Gyn 120.6 (2012): 1273-1282.