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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Development and Implementation of a Standardized Clinical Pathway for Super Morbidly Obese Parturient undergoing elective Cesarean Delivery

Abstract Number: S1C-2
Abstract Type: Case Report/Case Series

Aya A. Elsaharty M.D1 ; Ian McConachie M.D, FRCA, FRCPC2; Sudha Singh M.D, FRCPC3


Super Morbid Obesity (SMO) is increasing in the obstetric population. Women with BMI≥50 having Caesarean Delivery (CD) pose significant challenges to the anesthesiologist (1). Review of our practices showed variation in care provided to SMO parturients undergoing elective CD with regards to mode of anesthesia, operating room setup preparation time which ultimately impacted the overall procedural time, patient satisfaction and post-operative recovery time. Clinical pathways translate evidence for specific clinical procedure into structured multidisciplinary plans and are increasingly used to improve perioperative quality of care. We report the development of a clinical pathway to facilitate perioperative and anesthetic care provided to SMO patients undergoing elective CD.


REB approval was not required for this quality improvement project. Multiple stakeholders (anesthesiologists, obstetricians, nurses, anesthesia assistants, operating room aides) were involved in pathway development(Fig 1). Guidelines on perioperative management of surgical obese patients (2) were used to aid in the pathway development. The pathway was activated through iterative PDSA (Plan, Do, Study, Act) cycles. Thirteen criteria of adherence to the pathway were identified and the main outcome was the percentage of adherence to these criteria.


PDSA cycle 1 involved 1 patient and total adherence to the pathway criteria was 61%. In PDSA cycle2 that involved 2 patients, simplified documentation on the pathway was used and study team members actively available to educate users. The percentage of adherence to criteria improved to 84% and 92%. During the PDSA cycles, this pathway achieved buy-in by all parties involved in patient care. A third PDSA cycle is currently taking place disseminating the pathway in the Birthing Unit and educating different staff members about its use.


Implementation of standardized operative pathways have shown to improve clinical outcomes and patient satisfaction while reducing costs for different surgical procedures (3). The complexity of care in this high-risk group compels a clinical pathway to apply evidence-based medical principles, decrease process variation, and improve outcomes. Further research is planned to study the impact of this pathway on patient outcomes.


1- Acta Anaesthesiol Scand 2008; 52:6-19

2- Anaesthesia 2015;70: 859–876.

3- Reg Anesth Pain Med 2013;38: 533–538

SOAP 2018