(764) Implementation of an Obstetric Enhanced Recovery After Surgery Protocol: Impact on Perioperative Pain Management Practices

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: To evaluate the impact of implementing an institutional enhanced recovery after surgery (ERAS) protocol on perioperative pain management practices among patients undergoing non-urgent cesarean delivery at a tertiary academic medical center.

Study Design: We conducted a retrospective cohort study of pregnant women undergoing non-urgent cesarean delivery between October 2020 – October 2021. Data pertaining to demographic characteristics, pregnancy comorbidities – including chronic hypertension, hypertensive disorders of pregnancy, pregestational and gestational diabetes, and tobacco use, as well as improvement science based process and outcome measures related to multimodal analgesia utilization, postoperative pain scores, narcotic administration and opioid prescribing at discharge were abstracted from electronic health records and compared across 2 groups – pre and post ERAS implementation, using student t-test, Pearson’s chi-square, Mann-Whitney U, and/or Fisher’s exact test, as indicated. Statistical significance was set at p < .05.

Results: Demographic characteristics and pregnancy comorbidities were similar across pregnant women undergoing non-urgent cesarean delivery in the pre (N = 168) and post (N = 123) implementation groups. As compared to pre-ERAS (90.5%), the post-implementation group (82.9%) had lesser postoperative narcotic use, showing a trend towards significance. Postoperative acetaminophen use increased (p < .0001) while morphine (p = .02) and hydromorphone (p < .0001) use decreased significantly in the post-ERAS implementation cohort. Pain scores and morphine milliequivalents (MME) on postoperative day 1 and 2 were similar across study groups, as were administration of oxycodone, ketorolac and ibuprofen. Notably, patients in the post-implementation cohort had significantly lesser (p = .04) MME prescribed at discharge.

Conclusion: Implementation of an Obstetric ERAS protocol can facilitate the attainment of comparable pain scores with the potential to decrease narcotic administration in the immediate postoperative period and upon discharge.

Primary & Presenting Author(s)

Jennifer E. Powel, MD
Saint Louis University School of Medicine
Long Branch, New Jersey, United States

Coauthor(s)

NP
Nikita Peramsetty, BS
Saint Louis University School of Medicine
St. Louis, Missouri, United States
MH
Madeline Huber, BS
Saint Louis University School of Medicine
St. Louis, Missouri, United States
KN
Krithika Narayana Kumanan, MPH
Saint Louis University School of Medicine
St. Louis, Missouri, United States
Alexandra S. Ragsdale, MD (she/her/hers)
Fellow Physician
Saint Louis University School of Medicine
St. Louis, Missouri, United States
Zachary D. Stanley, MD (he/him/his)
Fellow Physician
Saint Louis University/St. Mary's SSM Heatlh
St. Louis, Missouri, United States
KC
Katherine S. Childress, MD
Saint Louis University School of Medicine
St. Louis, Missouri, United States
NC
Niraj R. Chavan, MD, MPH
Saint Louis University School of Medicine
St. Louis, Missouri, United States