Implementation of Enhanced Recovery protocol to improve postoperative outcomes among patients who undergo Cesarean Section in Tertiary Hospitals in RWANDA

Abstract

Project: Implementation of enhanced recovery after surgery protocol to improve postoperative outcome among patients who undergo CS in Tertiary Hospital in RWANDA. Background: Worldwide, the percentage of medically indicated Cesarean sections continues to have a steady increase despite all measures taken to counter this trend. Birth by CS is associated with prolonged hospital stay. Evidence shows that implementation of enhanced recovery after surgery might resolve this problem. Enhanced recovery after surgery is a multidisciplinary approach involving a team of surgeons, anesthesiologists, midwives, nurses, and other staff who take care of patients. Aims and Objectives: improve postoperative outcomes among pregnant women who undergo CS, by decreasing hospital length of stay, improve maternal outcome and satisfaction, and decrease postoperative complications a well as maximizing post-operative pain control with low opioid use. Methodology: Prospective cross section study was conducted on pregnant women who were undergoing medically indicated Cesarean section. At UTHK, pregnant women were treated following ERAS protocol designed by SOAP whereas at Muhima District Hospital, they were managed with routine practice. Results: Compared to the control group, the ERAS group had early ambulation where 86% of patients were able to both sit in bed within 4 hours and get out of the bed within 12 hours. There was a statistically significant difference in the median pain scores within 3 hours and 6 hours among the 2 groups where participants from non-ERAS group expressed more pain compared to the participants from ERAS group (Mann Whitney U test, p<0.00`1) and ). No patient from ERAS group required opioid use postoperatively. Patient satisfaction was significantly higher in the ERAS group (p<0.001). The median length of hospitalization was significantly lower in the ERAS group than in the control group (Mann Whitney U test, p<0.001). Conclusions: Implementation of ERAS protocol resulted in improving significantly outcomes and satisfaction of patients by decreasing complications shortening the length of stay, reducing the pain score as well as opioids uses