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ERAS PROTOCOL IMPLEMENTATION FOR CESAREAN SECTION IN A SERBIAN HOSPITALS
Abstract Number: T1A-5
Abstract Type: Original Research
Introduction: Enhanced Recovery After Surgery (ERAS) protocols have been developed for cesarean delivery (CD) in several hospitals in UK (1) after having shown benefit for other surgeries. ERAS protocols have been adopted for non-CD surgeries in Serbia, but not for CD. We surveyed Serbian hospitals where CD is performed and compared whether elements of ERAS protocols for CD were differently implemented in hospitals with ERAS vs non-ERAS hospitals for non-CD surgeries.
Method: After Ethical Committee approval, a 22-item questionnaire was sent to all hospitals in Serbia (45 general hospitals and 4 university hospitals) Overall responses were recorded and the responses between those hospitals with ERAS protocols in place were compared with those without. Pearson’ chi square test was used where appropriate.
Results: Responses were obtained from 46/49 hospitals (94 % response rate). 25% of surveyed hospitals reported use of elements of ERAS protocols for CD and the responsibility for counseling was shared between the obstetrician or anesthesiologist. 75-80% of hospitals reported admitting the patient the day before elective CDs, use of maternal bowl preparation the day of CD, and maternal DVT prophylaxis. 22 % of the time gabapentin was given for analgesia. In all hospitals, urinary catheters were removed on the postoperative day 1(POD1), intraoperative maternal temperature monitoring was used 11% of the time, and active warming of either IV fluids or the patient occurred less than 5% of the time. 90% of patients did not eat solid food until the POD1. The use of neuraxial narcotics for postoperative analgesia was used <10 % of the time overall No differences between groups were reported for the above ERAS, for hospitals more often reported antibiotics within 30 minutes of a CD skin to skin contact during CD under NA, use of NA for both elective and emergency CD and earlier PO intake; 33% of the ERAS patients were discharged within 3 days of delivery, vs. non no-ERAS patients, and 20% No-ERAS patient stayed > 6 days compared to non in ERAS group, but fewer patients ambulated on the POD 1. ERAS hospitals reported more deliveries. (Table 1)
Conclusion: At Serbian hospitals some elements of ERAS protocols for CD are in use. Successful ERAS protocol implementation for CD in Serbian hospitals will require the great efforts of a multidisciplinary medical staff team and the outside community.
1. Aluri S, et al. IJOA 23(2):157-160