Impact of enhanced recovery after cesarean delivery on maternal outcomes: A systematic review and meta-analysis.

Abstract Background This meta-analysis explores the impact of enhanced recovery after cesarean delivery (ERAC) on maternal outcomes. Methods We searched 4 databases (Web of Science, Embase, PubMed and CINAHL) in October 2020 without date limiters, for studies quantitatively comparing ERAC implementation to a control group. The primary outcome was length of hospital stay and secondary outcomes included time to mobilization and time to urinary catheter removal, opioid consumption, readmission rates and cost savings. Mean differences and odds ratios (MD and OR with 95% confidence intervals) were calculated. Levels of evidence were assessed using GRADE. Results Twelve studies involving 17,607 patients (9693 without ERAC and 7914 with ERAC) were included. ERAC was associated with reduced: length of hospital stay (MD −0.51 days [−0.94, −0.09]; p = 0.018; I2 = 99%), time to first mobilization (MD −11.05 h [−18.64, −3.46]; p = 0.004; I2 = 98%), time to urinary catheter removal (MD −13.19 h [−17.59, −8.79]; p  Conclusion ERAC is associated with reduction in length of stay, times to first mobilization and urinary catheter removal and opioid consumption. ERAC does not significantly affect maternal hospital readmission rates following discharge. Further studies are required to determine which ERAC interventions to implement and which outcomes best determine ERAC efficacy.