NCT02956616

Enhanced Recovery at Cesarean Birth to Improve Postoperative Outcomes and Reduce Postoperative Length of Stay

• Status: Completed
• Phase: Phase 2
• Study type: Interventional
• Enrollment: 118 (actual)
• Sponsor: Montefiore Medical Center · Academic / Other
• Sex: Female
• Age: 18 Years
• Healthy volunteers: Accepted

Summary

To determine whether women randomized to an enhanced recovery program will have improved postoperative outcomes including improved breastfeeding initiation and continuation, reduction in hospital length of stay without compromising patient satisfaction in comparison to standard postoperative recovery interventions.

Detailed description

The investigators hypothesize that an enhanced recovery program which includes several evidence based interventions at the time of cesarean birth in obstetrics will promote early ambulation, resumption of diet and initiation of breastfeeding, and reduce postoperative hospital length of stay. Enhanced Recovery Protocol Components: 1. Provide preoperative education about the perioperative recovery experience including postoperative analgesia, thromboprophylaxis and breastfeeding education 2. Minimize preoperative starvation times 1. Moderate amount of clears up to 2 hours prior to anesthesia 2. Solid foods up to 6-8 hours prior to anesthesia 3. Prophylactic antibiotics 4. Venous thromboembolism prophylaxis (mechanical) initiated at the time of cesarean birth and continued postoperatively 5. Chewing gum (Xylitol) to reduce postoperative ileus 6. Routine administration of Non-steroidal anti-inflammatory drug, Ketorolac, 15mg every hour for 24 hours postoperatively to minimize postoperative narcotic use 7. Early initiation of feeding after cesarean, immediately for clears, 30 minutes for regular diet as tolerated 8. Early removal of urinary catheter (12 hours postoperatively) 9. Early removal of dressing (6 hours postoperatively) 10. Early mobilization at 12 hours after delivery 11. Early skin-to- skin/breastfeeding initiation 12. Early incentive spirometry Currently, patients are encouraged to ambulate on the first post-operative day, but it is largely left up to the patient when to actually begin to ambulate. They are similarly offered a diet on the first postoperative day but are not encouraged to eat. Breastfeeding is more systematically encouraged early as part of Montefiore's effort to get baby friendly designation. And finally, patients are typically discharged on postoperative day number three unless complications arise in the newborn or the mother. As part of this study, patients in both the enhanced recovery and usual care group will be offered the opportunity to be discharged from the hospital on postoperative day number 2 if their recovery is progressing well and if they choose not to leave then they will be encouraged to return home on postoperative day number 3 according to the current standard of care.

Conditions

• Cesarean Section

Interventions

Type	Name	Description
DRUG	ketorolac	Ketorolac, sold under the brand name Toradol among others, is a nonsteroidal anti-inflammatory drug in the family of heterocyclic acetic acid derivatives, used as an analgesic. It is considered a first-generation NSAID. Ketorolac acts by inhibiting the bodily synthesis of prostaglandins.
OTHER	Chewing Gum	Xylitol chewing gum will be provided to patients immediately after the procedure and will be provided 3 times per day for a duration of 30 minutes at each time, based on a metanalysis and systematic review. Patient's will be encouraged on its use for return of bowel function.
PROCEDURE	Enhanced Recovery Protocol	enhanced recovery protocol (detailed previously) will include several evidence-based recommendations including early ambulation, early diet initiation, early removal of urinary catheter, early removal of postoperative dressing and standing ketorolac for 24 hours postoperatively.

Timeline

• Start date: 2017-09-01
• Primary completion: 2018-06-15
• Completion: 2018-06-15
• First posted: 2016-11-07
• Last updated: 2019-04-25
• Results posted: 2019-04-25

Locations

1 site across 1 country: United States

Regulatory

• FDA-regulated drug study