Evaluating the impact of an enhanced recovery programme on the Obstetric Quality-of-Recovery score (ObsQoR-10) after elective Caesarean section in a South African public hospital: a prospective before–after study

Abstract

Background

Caesarean section is a common surgical procedure, accounting for almost a third of all surgical procedures in low- middle-income countries. Enhanced recovery after Caesarean section (ERAC) programmes are rarely implemented in resource-limited settings. This study evaluated a tailored enhanced recovery programme's impact on quality of recovery after elective Caesarean section in a Johannesburg public hospital.

Methods

This was a prospective, observational, before–after cohort study. Fifty-two patients (aged ≥18 yr) undergoing elective Caesarean section were analysed, comprising a pre-ERAC cohort (n=25), analysed from 8 to 22 April 2024 and a post-ERAC cohort (n=27), analysed from 3 to13 June 2024. The primary outcome was postpartum recovery measured by the Obstetric Quality of Recovery-10 score.

Results

There was a significant improvement in Obstetric Quality of Recovery-10 scores post-ERAC, with a difference in medians of 9 between cohorts (95% confidence interval: 6–14; P<0.001). There was also a significant reduction in opioid consumption with a median decrease of 10 mg oral morphine equivalent in the post-ERAC cohort in the first 24 h after operation (95% confidence interval: −26 to 6; P<0.001). Time to urinary catheter removal, time to first oral intake, time to first mobilisation, and preoperative fasting for liquids all showed significant improvement in the post-ERAC cohort. There was no difference in length of stay and other secondary outcomes.

Conclusion

This study demonstrates that ERAC implementation in a resource-limited setting is feasible and can enhance maternal recovery after elective Caesarean section. These findings highlight the potential for ERAC programs to significantly improve patient-centred outcomes in low-middle income countries.