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