Improved Outcomes With an Enhanced Recovery Approach to Cesarean Delivery.

Abstract:

OBJECTIVE:To examine the results of a quality-improvement study that implemented an enhanced recovery after surgery (ERAS) program for cesarean delivery. METHODS:A pre-post design was used to assess changes in opioid use, length of stay, and costs among all patients undergoing cesarean delivery before and after implementation of an evidence-based ERAS pathway for the preoperative, intraoperative, and postoperative management of patients beginning December 2018. RESULTS:A total of 3,679 cesarean deliveries (scheduled and emergent) were included from January 1, 2018, through August 31, 2019, of which 2,171 occurred before implementation on December 17, 2018, and 1,508 occurred postimplementation. Eighty-four percent of patients received opioids as inpatients after cesarean delivery during the preimplementation period, as compared with 24% in the postimplementation period (odds ratio [OR] 16.8, 95% CI 14.3-19.9). Among patients who required any opioids, the total morphine milligram equivalents also significantly decreased (median 56.5 vs 15.0, mean relative change 0.32, 95% CI 0.28-0.35). Compared with the preimplementation period, those in the postimplementation period had a shorter postcesarean length of stay (3.2 vs 2.7 days, mean relative change 0.82, 95% CI 0.80-0.83, median 3 days in both periods), lower median direct costs by $349 (mean relative change 0.93, 95% CI 0.91-0.95), and no change in the 30-day readmission rate (1.4% vs 1.7%, OR 0.83, 95% CI 0.49-1.41). CONCLUSION:An ERAS approach for the cesarean delivery population is associated with improved outcomes including decreases in opioid use, length of stay, and costs.

journal_name

Obstet Gynecol

authors

Mullman L,Hilden P,Goral J,Gwacham N,Tauro C,Spinola K,Rosales K,Collier S,Holmes L,Maccione J,Pitera R,Miller R,Yodice P

doi

10.1097/AOG.0000000000004023

subject

Has Abstract

pub_date

2020-10-01 00:00:00

pages

685-691

issue

4

eissn

0029-7844

issn

1873-233X

pii

00006250-202010000-00008

journal_volume

136

pub_type

杂志文章
  • Prenatal sonographic findings of congenital duplication of the cecum.

    abstract:BACKGROUND:Alimentary tract duplications are rare congenital lesions that may arise at any location throughout the gastrointestinal tract. The most common site of enteric duplications is the ileum, with only 13% of cases occurring in the colon. CASE:Prenatal sonography at 39 weeks' gestation showed a cystic structure ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Haratz-Rubinstein N,Sherer DM

    更新日期:2003-05-01 00:00:00

  • Bombay blood type and use of red cell apheresis during pregnancy.

    abstract:BACKGROUND:Bombay blood type is among the rarest in the world and is associated with anti-H antibodies. These antibodies cause severe hemolysis when exposed to any blood product except Bombay and have been reported to cause hemolytic disease of the newborn. CASE:A primigravid woman with Bombay blood type received eryt...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0b013e3181f738f3

    authors: Sprawka N,Young C,O'Brien B

    更新日期:2011-02-01 00:00:00

  • Improved survival of Asians with corpus cancer compared with whites: an analysis of underlying factors.

    abstract:OBJECTIVE:To compare the clinicopathologic prognosticators and survival of Asians and whites with corpus cancer. METHODS:Demographic, clinicopathologic, and survival data were obtained from the 1992-2001 Surveillance, Epidemiology, and End Results Program. Statistical analyses were performed by Kaplan-Meier methods an...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/01.AOG.0000195062.75199.7d

    authors: Zhang MM,Cheung MK,Osann K,Lee MM,Gomez SS,Whittemore AS,Husain A,Teng NN,Chan JK

    更新日期:2006-02-01 00:00:00

  • A new technique for reduction of prolapsed fetal membranes for emergency cervical cerclage.

    abstract::A new method to replace fetal membranes that have prolapsed through an incompetent cervix, which includes overfilling of the urinary bladder, was successful in four consecutive patients who presented with this clinical entity. ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Scheerer LJ,Lam F,Bartolucci L,Katz M

    更新日期:1989-09-01 00:00:00

  • Differences in primary compared with secondary vestibulodynia by immunohistochemistry.

    abstract:OBJECTIVE:To assess whether primary and secondary vestibulodynia represent different pathologic pathways. METHODS:This was an analysis of archived vestibulectomy specimens from 88 premenopausal women with vestibulodynia (2002-2008). Patient records were reviewed to classify the type of vestibulodynia, duration of symp...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0b013e31821c33dc

    authors: Leclair CM,Goetsch MF,Korcheva VB,Anderson R,Peters D,Morgan TK

    更新日期:2011-06-01 00:00:00

  • Reliability of intrauterine pressure measurements.

    abstract::The reliability of intrauterine pressure measurements was studied by placing two catheters in the same uterus in women in labor. Nineteen parturients were studied, five with two Intran I catheters in different pockets of amniotic fluid, five with two Intran II catheters in different pockets, and nine with two Intran I...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Arulkumaran S,Yang M,Tien CY,Ratnam SS

    更新日期:1991-11-01 00:00:00

  • Hysteroscopic endometrial ablation with the Nd:Yag laser using a nontouch technique.

    abstract::Thirty-six patients with menorrhagia were treated with a technique for laser destruction of the endometrium in which the end of the fiberoptic guide of the Nd:Yag laser is not allowed to come in contact with the endometrium. The results were excellent in 93.9% of the 33 patients followed over three months. Amenorrhea ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Loffer FD

    更新日期:1987-04-01 00:00:00

  • Deceleration/contraction ratios as an index of fetal health during labor.

    abstract::Internal FHR tracings of 259 patients with variable decelerations and 49 with late decelerations were analyzed for frequency and severity of the pattern in an attempt to correlate with fetal pH or Apgar score at 1 minute. A significant increase in the risk of fetal acidosis was associated with a frequency of greater t...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Lin CC,Schulman H,Saldana LR

    更新日期:1978-06-01 00:00:00

  • Spontaneous pneumothorax in pregnancy: a case report and review of the literature.

    abstract::A 19-year-old primigravida at term presented with bilateral, spontaneous pneumothorax. The maternal and infant outcomes were successful. The impact on pregnancy is discussed, and suggestions are made for obstetric management. ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Farrell SJ

    更新日期:1983-09-01 00:00:00

  • Postoperative fatigue negatively impacts the daily lives of patients recovering from hysterectomy.

    abstract:OBJECTIVE:To assess, from the patient's perspective, the prevalence and impact of postoperative fatigue after hysterectomy and to increase understanding of physician-patient communications before and after surgery regarding recovery and diminished postoperative energy level. METHODS:We completed a telephone survey of ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/s0029-7844(01)01622-2

    authors: DeCherney AH,Bachmann G,Isaacson K,Gall S

    更新日期:2002-01-01 00:00:00

  • Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases.

    abstract::The vaginal microbiota has great significance in maintaining vaginal health and protecting the host from disease. Recent advances in molecular techniques and informatics allow researchers to explore microbial composition in detail and to compare the structure of vaginal microbial communities with behavior and health o...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,评审

    doi:10.1097/AOG.0000000000001932

    authors: Lewis FMT,Bernstein KT,Aral SO

    更新日期:2017-04-01 00:00:00

  • Appendectomy in the surgical treatment of endometriosis.

    abstract::To address the question of when to perform an appendectomy in the surgical treatment of endometriosis, a series of 500 consecutive appendectomies was reviewed. In 104 patients with pelvic endometriosis who were undergoing appendectomy, the appendix was a relatively common (13%) extragenital site of endometriosis. Gros...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Pittaway DE

    更新日期:1983-04-01 00:00:00

  • Delayed Umbilical Cord Clamping After Birth: ACOG Committee Opinion, Number 814.

    abstract::Delayed umbilical cord clamping appears to be beneficial for term and preterm infants. In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. There is a small increa...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0000000000004167

    authors:

    更新日期:2020-12-01 00:00:00

  • Case-control study of cancer of the vulva.

    abstract::A case-control study of 209 vulvar cancer patients and 348 community controls allowed assessment of risk factors for this rare tumor. As with cervical cancer, risk increased with the number of reported lifetime sexual partners, with five or more partners associated with two- to threefold increases in risk compared wit...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Brinton LA,Nasca PC,Mallin K,Baptiste MS,Wilbanks GD,Richart RM

    更新日期:1990-05-01 00:00:00

  • Patterns and progress in ovarian cancer over 14 years.

    abstract:OBJECTIVE:To estimate the change in survival rates of women with ovarian cancer during the past 14 years. METHODS:Women diagnosed with epithelial, germ cell, sarcomas, and sex-cord stromal ovarian tumors were identified from the Surveillance Epidemiology and End Results Database. Demographic and clinicopathologic fact...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/01.AOG.0000231680.58221.a7

    authors: Chan JK,Cheung MK,Husain A,Teng NN,West D,Whittemore AS,Berek JS,Osann K

    更新日期:2006-09-01 00:00:00

  • Two distinct oral routes of misoprostol in mifepristone medical abortion: a randomized controlled trial.

    abstract:OBJECTIVE:To study the efficacy, safety, and acceptability of oral immediately swallowed and buccal misoprostol 800 mcg after mifepristone 200 mg for terminating pregnancy through 63 days since the last menstrual period (LMP). METHODS:This seven-site study randomly assigned 966 women seeking abortions to oral or bucca...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1097/AOG.0b013e31818d8eb4

    authors: Winikoff B,Dzuba IG,Creinin MD,Crowden WA,Goldberg AB,Gonzales J,Howe M,Moskowitz J,Prine L,Shannon CS

    更新日期:2008-12-01 00:00:00

  • Renal failure wit XY gonadal dysgenesis: report of the second case.

    abstract::The second case is reported of renal failure in association with XY gonadal dysgenesis. The random association of these conditions appears unlikely. Recognition of a possible association is important because of potential fatality due to renal failure or gonadoblastoma in unrecognized cases. In groups at risk, follicle...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Harkins PG,Haning RV Jr,Shapiro SS

    更新日期:1980-12-01 00:00:00

  • Relaxin secretion in early pregnancy.

    abstract::Relaxin is a peptide hormone produced solely by the corpus luteum of pregnant women. Extracts of human pregnancy corpora lutea have relaxin activity in bioassay systems. This activity can be measured in a heterologous porcine radioimmunoassay (RIA). Immunoreactive relaxin was undetectable in the RIA in 51 nonpregnant ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Quagliarello J,Steinetz BG,Weiss G

    更新日期:1979-01-01 00:00:00

  • Estrogen improves psychological function in asymptomatic postmenopausal women.

    abstract::Estrogen treatment of postmenopausal women has been suggested to improve mood and psychological function. However, this remains controversial because previous studies involved heterogeneous groups, were not double blind, and included women who were also experiencing somatic symptoms that were relieved by estrogen. A r...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Ditkoff EC,Crary WG,Cristo M,Lobo RA

    更新日期:1991-12-01 00:00:00

  • Use of recombinant activated factor VII in primary postpartum hemorrhage: the Northern European registry 2000-2004.

    abstract:OBJECTIVE:To collect data from nine European countries for cases of obstetric hemorrhage between 2000 and 2004 in which recombinant activated factor VII (rFVIIa) was used. METHODS:The cases were identified through national surveys. Standardized case report forms included sociodemographic details, past medical and obst...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/01.AOG.0000288515.48066.99

    authors: Alfirevic Z,Elbourne D,Pavord S,Bolte A,Van Geijn H,Mercier F,Ahonen J,Bremme K,Bødker B,Magnúsdóttir EM,Salvesen K,Prendiville W,Truesdale A,Clemens F,Piercy D,Gyte G

    更新日期:2007-12-01 00:00:00

  • Reproductive correlates of depressive symptoms among low-income minority women.

    abstract:OBJECTIVE:To estimate the prevalence of depressive symptoms among women of reproductive age attending family planning clinics across southeast Texas in addition to demographic and reproductive characteristics associated with these symptoms. METHODS:A retrospective, self-reported, paper-and-pencil survey designed to as...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/j.obstetgynecol.2003.08.012

    authors: Berenson AB,Breitkopf CR,Wu ZH

    更新日期:2003-12-01 00:00:00

  • Detection of Chlamydia trachomatis infection by direct immunofluorescence staining of genital secretion.

    abstract::A monoclonal antibody specific for Chlamydia trachomatis (Syva Microtrak) was used to stain directly 249, 127, and 67 specimens obtained from the cervix, and the female and the male urethra, respectively. The Microtrak system identified 100% or 23 culture-positive cases from the cervix (prevalence 9.2), 100% or seven ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Wiesmeier E,Bruckner D,Black M

    更新日期:1987-03-01 00:00:00

  • Pelvic Organ Prolapse: ACOG Practice Bulletin Summary, Number 214.

    abstract::Pelvic organ prolapse (POP) is a common, benign condition in women. For many women it can cause vaginal bulge and pressure, voiding dysfunction, defecatory dysfunction, and sexual dysfunction, which may adversely affect quality of life. Women in the United States have a 13% lifetime risk of undergoing surgery for POP ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0000000000003520

    authors:

    更新日期:2019-11-01 00:00:00

  • Magnetic resonance imaging in Mayer-Rokitansky-Küster-Hauser syndrome.

    abstract::Six girls with suspected Rokitansky syndrome underwent magnetic resonance imaging (MRI) and then sonography and laparoscopy to confirm the clinical diagnosis and define the precise characteristics of the malformation. The uterus was missing in all; four had müllerian rudiments in place of the uterus, which were cavita...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Fedele L,Dorta M,Brioschi D,Giudici MN,Candiani GB

    更新日期:1990-10-01 00:00:00

  • Perinatal infection with Torulopsis glabrata: a case associated with maternal sickle cell anemia.

    abstract::Torulopsis glabrata is a yeast of low virulence and commensal within the female genitourinary tract. The first case of congenital infection with Torulopsis glabrata was reported in 1980. An additional example of perinatal Torulopsis infection which is associated with maternal sickle cell anemia is reported. The most c...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Sander CH,Martin JN,Rogers AL,Barr M Jr,Heidelberger KP

    更新日期:1983-03-01 00:00:00

  • Remote hemodynamics and renal function in formerly preeclamptic women.

    abstract:OBJECTIVE:Women with a history of preeclampsia have an increased risk of developing chronic hypertension and cardiovascular disease. However, little is known about the mechanism responsible for vascular disease in formerly preeclamptic women. The aim of our study was to test whether preeclampsia predisposes to central ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0b013e31819caf0f

    authors: Spaan JJ,Ekhart T,Spaanderman MEA,Peeters LLH

    更新日期:2009-04-01 00:00:00

  • A new abortion technique: intravaginal and intramuscular prostaglandin.

    abstract::The 15-methyl analog of prostaglandin F2 alpha (15-ME-PGF2 alpha), administered in a 3-mg dose via a single vaginal suppository and supplemented at 24 hours by intramuscular injection(s) of 250 micrograms, successfully induced abortion in 80 of 81 patients in the midtrimester of pregnancy. The mean abortion time was 1...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Lauersen NH,Den T,Scher J,Iliescu C,Wilson KH

    更新日期:1981-07-01 00:00:00

  • Reducing postpartum depressive symptoms among black and Latina mothers: a randomized controlled trial.

    abstract:OBJECTIVE:To estimate the effectiveness of a behavioral educational intervention to reduce postpartum depressive symptoms among minority mothers. METHODS:We recruited 540 self-identified black and Latina mothers during their postpartum hospital stay and randomized them to receive a behavioral educational intervention ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/AOG.0b013e318250ba48

    authors: Howell EA,Balbierz A,Wang J,Parides M,Zlotnick C,Leventhal H

    更新日期:2012-05-01 00:00:00

  • Neurodevelopmental Outcome After a Single Course of Antenatal Steroids in Children Born Preterm: A Systematic Review and Meta-analysis.

    abstract:OBJECTIVE:To systematically review and integrate data on the neurodevelopmental outcome of children after administration of a single course of antenatal corticosteroids for threatened preterm labor. DATA SOURCES:MEDLINE, Scopus, CENTRAL, and www.clinicaltrials.gov (inception to August 2014) using combinations of the t...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,meta分析,评审

    doi:10.1097/AOG.0000000000000748

    authors: Sotiriadis A,Tsiami A,Papatheodorou S,Baschat AA,Sarafidis K,Makrydimas G

    更新日期:2015-06-01 00:00:00

  • Advanced abdominal pregnancy resulting from late uterine rupture.

    abstract:BACKGROUND:Advanced abdominal pregnancy is rare, and one that occurs after uterine rupture with delivery of a viable fetus is exceptional. CASE:A multiparous patient was admitted at 29 weeks of gestation for conservative management of placenta previa. She complained of intermittent abdominal pain, but repeated assessm...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/01.AOG.0000279451.51446.c1

    authors: Naim NM,Ahmad S,Siraj HH,Ng P,Mahdy ZA,Razi ZR

    更新日期:2008-02-01 00:00:00