Effects of enhanced recovery after cesarean section on hospital length of stay and Obstetric Quality-of-Recovery score (ObsQoR-11): a randomized controlled trial

There is growing interest in improving recovery after cesarean section and optimizing the childbirth experience due to the declining fertility rate. However, studies on Enhanced Recovery After Cesarean Section (ERAC) implementation and the parturient’s experience remain scarce. This study aims to compare the effects of the ERAC and standard of care (SOC) protocol on hospital length of stay (LOS) and Obstetric Quality-of-Recovery score (ObsQoR-11). A randomized clinical trial enrolling pregnant women was conducted at a single center. Participants were randomized in a ratio of 1:1 to the ERAC group or the SOC group. ERAC protocol involved multiple evidence-based interventions: reduced fasting intervals, early mobilization and function training, early urinary catheter removal, and multimodal analgesia. The primary outcome was LOS and ObsQoR-11 score. The secondary outcomes were the global health numeric rating scale (NRS), the time to first flatulence, the time to first off-bed activity, and the postoperative visual analog scale (VAS) scores. Fetal Apgar scores and postoperative complications were recorded. A total of 140 participants were finally analyzed. There was no significant difference in the LOS between the ERAC and SOC groups (55.0 ± 11.6 h vs. 55.5 ± 12.2 h, P = 0.804). The ObsQoR-11 score was significantly higher in the ERAC group compared with the SOC group (77 IQR, 59–89.25 vs. 60 IQR, 50–70, median difference 16, 95% CI 10–22, P < 0.001). The global health NRS score was significantly higher in the ERAC group. The time to first off-bed activity and the time to first flatulence were significantly shorter in the ERAC group. The VAS scores at the postoperative 24 h and 36 h were significantly lower in the ERAC group than in the SOC group. Fetal Apgar scores were similar in both groups. There was no difference in the incidence of postoperative nausea and vomiting, urinary retention, wound infection, puerperal sepsis, and readmission between the two groups. Compared with the SOC protocol, the ERAC protocol had no significant effect on the LOS while significantly reducing the ObsQoR-11 score and the global health NRS score. Use of an ERAS protocol is feasible and improves recovery quality in parturients. The improvement in recovery experience, without increasing LOS or costs, underscores the intrinsic value of ERAC in promoting patient-centered care. Registered in the Chinese Clinical Trial Registry (ChiCTR2100046887) on May 29, 2021. https://www.chictr.org.cn/showproj.html?proj=126128.