Risk factors for failed enhanced recovery after planned caesarean delivery

Abstract

Introduction: The introduction of the Enhanced Recovery After Surgery (ERAS) protocol in the context of planned caesarean sections is a recent development, and the risk factors leading to the failure of this protocol remain largely unknown.

Objective: To identify the pre-operative maternal and obstetrical characteristics associated with failure of the ERAS protocol.

Materials and methods: The ERAS protocol was implemented at Hôpital Nord, Marseille, in August 2020, based on recent literature. A retrospective cohort study was conducted from November 2020 to 2021, which included women who underwent planned caesarean sections under the ERAS protocol. The primary outcome, protocol failure, was a composite of hospitalization for >5 days due to maternal causes, urinary retention necessitating catheterization, gastrointestinal obstruction, admission to the intensive care unit, or early reintervention. The investigated factors encompassed maternal sociodemographic characteristics, medical, surgical, and obstetric history, along with outcomes of the current pregnancy.

Results: Of the 147 included women, 7.5 % experienced a failure of the ERAS protocol due to extended hospital stays exceeding 5 days for maternal medical reasons or the installation of an indwelling urinary catheter to manage acute urinary retention. Regarding the maternal factors studied, obesity, a history of abdominal surgery, and multiple caesarean sections showed no association with an increased frequency of ERAS failure.

Conclusions: ERAS failure was seldom observed in the context of a planned caesarean section. No risk factors for ERAS failure were identified, further encouraging us to apply this protocol to all patients undergoing a planned caesarean section.

Keywords: Enhanced rehabilitation after surgery; Failure of enhanced rehabilitation after surgery; Medico-psycho-social vulnerabilities; Planned caesarean section.