Eras Protocol For Cesarean Section Does Not Lead To Decreased Length Of Stay (Los)

The objective of this study was to determine if the implementation of an Enhanced Recovery After Surgery (ERAS) protocol for Cesarean section would lead to a decreased length of stay, defined as a difference of 6 hours of greater, in a patient cohort including those of all gestational ages, anesthesia types (neuraxial and general), and acuity levels (emergent, urgent, scheduled). This project is a prospective cohort study comparing surgical outcomes for cesarean section patients before and after the implementation of an ERAs protocol. This study was powered for the primary outcome (LOS) to detect a 6-hour difference in length of stay with a target sample size of 336 patients, 168 pre-intervention and 168 post-intervention. Secondary outcomes included opioid use, NSAID use, and 30-day re-admission and ED visit rates. On analysis of descriptive variables there were no significant differences between groups. For the primary outcome the mean LOS pre-intervention was 80.5 hours and post-intervention was 82.3 hours, P=0.5146. This association remained non-significant when controlled for several potential confounders (hypertensive disorders, gestational diabetes, acuity of procedure, anesthesia type, etc). There was a trend towards fewer re-admissions and ED visits in the post-intervention cohort, however neither of these findings were statistically significant. The ERAS protocol did lead to significantly more NSAID use (p=0.044) but did not have a significant impact on opioid consumption (p=0.53). Implementation of an ERAS protocol for Cesarean Section did not lead to a clinically or statistically significant reduction in length of stay. This outcome suggests that there are other variables at the institutional level that may be contributing to the length of stay such as patient expectations/preferences, neonatal care, and provider counseling prior to delivery, which warrant further exploration.