A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda
BACKGROUND: Enhanced recovery after surgery (ERAS) expedites return to patient baseline and functional status by reducing surgical trauma, stress, and organ dysfunction. Despite the potential benefits of enhanced recovery protocols, limited research has been done in lowresource settings, where 95...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | en_US |
| Published: |
International Anesthesia Research Society
2020
|
| Subjects: | |
| Online Access: | http://hdl.handle.net/20.500.12493/431 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1800403078198853632 |
|---|---|
| author | Moris, Baluku Francis, Bajunirwe Joseph, Ngonzi Joseph, Kiwanuka Stephen, Ttendo |
| author_facet | Moris, Baluku Francis, Bajunirwe Joseph, Ngonzi Joseph, Kiwanuka Stephen, Ttendo |
| author_sort | Moris, Baluku |
| collection | KAB-DR |
| description | BACKGROUND: Enhanced recovery after surgery (ERAS) expedites return to patient baseline
and functional status by reducing surgical trauma, stress, and organ dysfunction. Despite the
potential benefits of enhanced recovery protocols, limited research has been done in lowresource
settings, where 95% of cesarean deliveries are emergent and could possibly benefit
from the application of ERAS protocols.
METHODS: In a prospective, randomized, single-blind, controlled trial, mothers delivering by
emergency cesarean delivery were randomly assigned to either an ERAS or a standard of care
(SOC) recovery arm. Patients in the ERAS arm were treated with a modified ERAS protocol that
included modified counseling and education, prophylactic antibiotics, antiemetics, normothermia,
restrictive fluid administration, and multimodal analgesia. They also received early initiation
of mobilization, feeding, and urethral catheter removal. The primary end point was length
of hospital stay. The secondary end points were complications and readmission rates. Mean
length of stay in the intervention and control arms were compared using t tests. Statistical
analyses were performed using STATA version 13 (College Station, TX).
RESULTS: A total of 160 patients were enrolled in the study, with 80 randomized to each arm.
There was a statistically significant shorter length of stay for the ERAS arm compared to SOC,
with a difference of −18.5 hours (P < .001, 95% confidence interval [CI], −23.67, −13.34). The
incidence of complications of severe pain and headache was lower in the ERAS arm compared
to SOC (P = .001 for both complications). However, pruritus was more common in the ERAS arm
compared to SOC (P = .023).
CONCLUSIONS: Use of an ERAS protocol for women undergoing emergency cesarean delivery in
a low-income setting is feasible and reduces length of hospital stay without generally increasing
the complication rate. (Anesth Analg 2020;130:769–76) |
| format | Article |
| id | oai:idr.kab.ac.ug:20.500.12493-431 |
| institution | KAB-DR |
| language | en_US |
| publishDate | 2020 |
| publisher | International Anesthesia Research Society |
| record_format | dspace |
| spelling | oai:idr.kab.ac.ug:20.500.12493-4312024-01-17T04:47:26Z A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda Moris, Baluku Francis, Bajunirwe Joseph, Ngonzi Joseph, Kiwanuka Stephen, Ttendo Cesarean Deliveries Recovery After Surgery BACKGROUND: Enhanced recovery after surgery (ERAS) expedites return to patient baseline and functional status by reducing surgical trauma, stress, and organ dysfunction. Despite the potential benefits of enhanced recovery protocols, limited research has been done in lowresource settings, where 95% of cesarean deliveries are emergent and could possibly benefit from the application of ERAS protocols. METHODS: In a prospective, randomized, single-blind, controlled trial, mothers delivering by emergency cesarean delivery were randomly assigned to either an ERAS or a standard of care (SOC) recovery arm. Patients in the ERAS arm were treated with a modified ERAS protocol that included modified counseling and education, prophylactic antibiotics, antiemetics, normothermia, restrictive fluid administration, and multimodal analgesia. They also received early initiation of mobilization, feeding, and urethral catheter removal. The primary end point was length of hospital stay. The secondary end points were complications and readmission rates. Mean length of stay in the intervention and control arms were compared using t tests. Statistical analyses were performed using STATA version 13 (College Station, TX). RESULTS: A total of 160 patients were enrolled in the study, with 80 randomized to each arm. There was a statistically significant shorter length of stay for the ERAS arm compared to SOC, with a difference of −18.5 hours (P < .001, 95% confidence interval [CI], −23.67, −13.34). The incidence of complications of severe pain and headache was lower in the ERAS arm compared to SOC (P = .001 for both complications). However, pruritus was more common in the ERAS arm compared to SOC (P = .023). CONCLUSIONS: Use of an ERAS protocol for women undergoing emergency cesarean delivery in a low-income setting is feasible and reduces length of hospital stay without generally increasing the complication rate. (Anesth Analg 2020;130:769–76) Kabale University 2020-07-09T07:19:55Z 2020-07-09T07:19:55Z 2020 Article http://hdl.handle.net/20.500.12493/431 en_US application/pdf International Anesthesia Research Society |
| spellingShingle | Cesarean Deliveries Recovery After Surgery Moris, Baluku Francis, Bajunirwe Joseph, Ngonzi Joseph, Kiwanuka Stephen, Ttendo A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda |
| title | A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda |
| title_full | A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda |
| title_fullStr | A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda |
| title_full_unstemmed | A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda |
| title_short | A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda |
| title_sort | randomized controlled trial of enhanced recovery after surgery versus standard of care recovery for emergency cesarean deliveries at mbarara hospital uganda |
| topic | Cesarean Deliveries Recovery After Surgery |
| url | http://hdl.handle.net/20.500.12493/431 |
| work_keys_str_mv | AT morisbaluku arandomizedcontrolledtrialofenhancedrecoveryaftersurgeryversusstandardofcarerecoveryforemergencycesareandeliveriesatmbararahospitaluganda AT francisbajunirwe arandomizedcontrolledtrialofenhancedrecoveryaftersurgeryversusstandardofcarerecoveryforemergencycesareandeliveriesatmbararahospitaluganda AT josephngonzi arandomizedcontrolledtrialofenhancedrecoveryaftersurgeryversusstandardofcarerecoveryforemergencycesareandeliveriesatmbararahospitaluganda AT josephkiwanuka arandomizedcontrolledtrialofenhancedrecoveryaftersurgeryversusstandardofcarerecoveryforemergencycesareandeliveriesatmbararahospitaluganda AT stephenttendo arandomizedcontrolledtrialofenhancedrecoveryaftersurgeryversusstandardofcarerecoveryforemergencycesareandeliveriesatmbararahospitaluganda AT morisbaluku randomizedcontrolledtrialofenhancedrecoveryaftersurgeryversusstandardofcarerecoveryforemergencycesareandeliveriesatmbararahospitaluganda AT francisbajunirwe randomizedcontrolledtrialofenhancedrecoveryaftersurgeryversusstandardofcarerecoveryforemergencycesareandeliveriesatmbararahospitaluganda AT josephngonzi randomizedcontrolledtrialofenhancedrecoveryaftersurgeryversusstandardofcarerecoveryforemergencycesareandeliveriesatmbararahospitaluganda AT josephkiwanuka randomizedcontrolledtrialofenhancedrecoveryaftersurgeryversusstandardofcarerecoveryforemergencycesareandeliveriesatmbararahospitaluganda AT stephenttendo randomizedcontrolledtrialofenhancedrecoveryaftersurgeryversusstandardofcarerecoveryforemergencycesareandeliveriesatmbararahospitaluganda |