Evaluating the impact of an enhanced recovery programme on the Obstetric Quality-of-Recovery score (ObsQoR-10) after elective Caesarean section in a South African public hospital: a prospective before-after study

Abstract

Background: Caesarean section is a common surgical procedure, accounting for almost a third of all surgical procedures in low- middle-income countries. Enhanced recovery after Caesarean section (ERAC) programmes are rarely implemented in resource-limited settings. This study evaluated a tailored enhanced recovery programme's impact on quality of recovery after elective Caesarean section in a Johannesburg public hospital.

Methods: This was a prospective, observational, before-after cohort study. Fifty-two patients (aged ≥18 yr) undergoing elective Caesarean section were analysed, comprising a pre-ERAC cohort (n=25), analysed from 8 to 22 April 2024 and a post-ERAC cohort (n=27), analysed from 3 to13 June 2024. The primary outcome was postpartum recovery measured by the Obstetric Quality of Recovery-10 score.

Results: There was a significant improvement in Obstetric Quality of Recovery-10 scores post-ERAC, with a difference in medians of 9 between cohorts (95% confidence interval: 6-14; P<0.001). There was also a significant reduction in opioid consumption with a median decrease of 10 mg oral morphine equivalent in the post-ERAC cohort in the first 24 h after operation (95% confidence interval: -26 to 6; P<0.001). Time to urinary catheter removal, time to first oral intake, time to first mobilisation, and preoperative fasting for liquids all showed significant improvement in the post-ERAC cohort. There was no difference in length of stay and other secondary outcomes.

Conclusion: This study demonstrates that ERAC implementation in a resource-limited setting is feasible and can enhance maternal recovery after elective Caesarean section. These findings highlight the potential for ERAC programs to significantly improve patient-centred outcomes in low-middle income countries.

Keywords: Caesarean section; ERAC; ObsQoR; enhanced recovery; low-middle income country; obstetric quality of recovery; patient-reported outcomes.

Figure 1

Flow diagram for study. ERAC, enhanced recovery after Caesarean section.

Figure 2

ObsQoR-10 scores in the pre-ERAC and post-ERAC cohorts. The median score is indicated by the black line and the inter-quartile range indicated by the shaded box. Individual data points are scattered for clarity. Black points indicate extreme values. ERAC, enhanced recovery after Caesarean section; ObsQoR-10, Obstetric Quality of Recovery-10.