Impact of a quality improvement intervention based on Enhanced Recovery After Surgery guidelines for cesarean delivery: an observational prospective study.

Objective: To assess whether the non-placement or early removal of urinary catheter (Ucath) could improve the recovery of patients undergoing cesarean delivery (CD). Moreover, we assessed the impact of neuraxial morphine in this study population. Design: Prospective cohort Setting: Hospital Clínic of Barcelona. Sample Patients undergoing CD Methods: Prospective cohort over a 10-month period. Main outcomes measures: Surgical time (ST), time to first spontaneous micturition (FSM), need for intermittent catheterization (Icath), time to first solid oral intake (FOI), time to mobilization (Tmob) and time to hospital discharge (THD). Results. Among 290 patients, those without or who had Ucath removed early (first 6h) displayed significantly shorter times to: FSM, FOI, Tmob and THD. Urinary retention (21.9 % vs 8.9 %, p = 0.004) and intermitent catheterization (39.7 % vs 19.6 %, p < 0.001) were more frequent when Ucath was not placed. Using morphine did not significantly increase postoperative times. Urinary retention was significantly higher when morphine was used in spinal anesthesia (8.7 % vs 21.8 %, p = 0.049). No differences were found in terms of nausea, vomiting and pruritus. Morphine was associated with better pain control at 6 and 12 h at rest. Conclusions. Not using or removing Ucath early had a positive impact on the postoperative care of CD. Neuraxial morphine was appropriate and safe and should be considered a first-line analgesic in CD.