Abstract
Background: The Enhanced Recovery After Surgery Cesarean Delivery (ERAS-CD) protocols published by the ERAS Society between 2018 and 2019 were developed with the same purpose as every other ERAS guideline: to offer the best available care to patients undergoing surgical procedures, using a multimodal and multidisciplinary approach based on the best clinical evidence.
Objective: We aimed to evaluate perioperative clinical outcomes following the introduction of ERAS-CD protocol elements and identify key factors in managing patients undergoing cesarean section to achieve early discharge at the Obstetrics and Gynecology Unit of Santa Chiara Hospital (Pisa, Italy).
Methods: Data used in this case-control retrospective study were collected from medical records of patients who underwent cesarean sections in 2023. Variables were categorized and described with frequencies and percentages. Statistical analysis was conducted initially with a univariate Chi-square test and subsequently with multivariate linear regression. The significance threshold was set at 0.05, using SPSS Version 29.
Results: Data from 413 medical records revealed significant associations for the failure of early discharge with gestational age (p <0.001), hypertension or preeclampsia (p =0.008), atypical fetal presentations (p =0.001), and post-partum anemia (p =0.001). The timing of urinary catheter removal and resumption of mobilization, elements of the ERAS protocol that have yet to be implemented, did not show a significant impact. Conclusions: Although the early removal of the urinary catheter and mobilization has not yet been implemented due to logistical and structural challenges in our obstetric setting, the optimal length of stay was achieved. Multiple studies have shown that the complete implementation of ERASCD protocols adding all the crucial elements will likely lead to a further reduction of the length of stay and additional benefits in many other aspects of the perioperative period.
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Copyright (c) 2025 Eliana R. Niño Basilotta, Andrea Giannini, Riccardo Morganti, Carlo Luchi, Francesa Monacci, Martina Benvenuti, Paolo Mannella, Stefano Luisi, Pietro Bottone, Tommaso Simoncini