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 Gynecoljournal_title
Obstetrics and gynecologyauthors
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 Pdoi
10.1097/AOG.0000000000004023subject
Has Abstractpub_date
2020-10-01 00:00:00pages
685-691issue
4eissn
0029-7844issn
1873-233Xpii
00006250-202010000-00008journal_volume
136pub_type
杂志文章abstract：:This month we focus on current research in maternal heart disease. Dr. Metz discusses four recent publications, which are concluded with a "bottom-line" that is the take-home message. A complete reference for each can be found on on this page along with direct links to abstracts. ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000003037
更新日期：2019-01-01 00:00:00
abstract：OBJECTIVE:To compare bleeding patterns between a 21/7-day triphasic norgestimate/ethinyl estradiol (E2) 25-microgram oral contraceptive pill (OCP) and a 24/4-day drospirenone/ethinyl E2 20-microgram OCP. METHODS:In a three-cycle, open-label, multicenter study, healthy, sexually active women were assigned randomly to a...
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.0b013e3181beab47
更新日期：2009-12-01 00:00:00
abstract：BACKGROUND:An existing model for fourth-degree laceration repair uses beef tongue with plastic or vinyl tubing. This modified model substitutes beef tripe for the anal mucosa and chicken leg muscles for the anal sphincter muscle analogs to create a realistic model. METHOD:Tripe is tunneled through the body of the trim...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000001908
更新日期：2017-03-01 00:00:00
abstract：OBJECTIVE:To estimate the incidence of gestational diabetes mellitus (GDM) according to The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and the pregnancy complications in women fulfilling these criteria but who are not considered diabetic according to the Canadian Diabetes Ass...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0b013e31826994ec
更新日期：2012-10-01 00:00:00
abstract：OBJECTIVE:To determine the effects of a selective estrogen receptor modulator, raloxifene, on postmenopausal endometrium. METHODS:Healthy postmenopausal women (n = 415) were randomly assigned to one of the following four groups: 60 or 150 mg/day raloxifene hydrochloride, 0.625 mg/day conjugated equine estrogens, or pl...
journal_title：Obstetrics and gynecology
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：10.1016/s0029-7844(99)00502-5
更新日期：2000-01-01 00:00:00
abstract：OBJECTIVE:Preoperative evaluation for pregnancy at our institution lacked standardization among individual health care providers and surgical services. This pilot project aimed to improve assessment for pregnancy before scheduled outpatient gynecologic surgical procedures. The Pregnancy Reasonably Excluded Guide incorp...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000002917
更新日期：2018-11-01 00:00:00
abstract：OBJECTIVE:To evaluate whether there was a change in prevalence of human papillomavirus (HPV) in the United States correlated with the introduction of HPV vaccines in both vaccinated and unvaccinated women. METHODS:We performed a retrospective review of prevalence data for women aged 18-29 years living in the United St...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000001760
更新日期：2016-12-01 00:00:00
abstract：OBJECTIVE:To estimate how implementation of the 2010 Affordable Care Act (ACA) might be associated with stage at diagnosis and time to treatment for women with ovarian cancer. METHODS:We conducted a retrospective cohort study using difference-in-differences analysis comparing stage at diagnosis and time to treatment b...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000003630
更新日期：2020-02-01 00:00:00
abstract：:This month we focus on current research in exercise in pregnancy. Dr. Blanchette discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts. ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000000658
更新日期：2015-02-01 00:00:00
abstract：:Full-time faculty numbers in academic departments of obstetrics-gynecology have resumed growth in the last three years, and now average 18.3 per department. Women are represented in a larger proportion than among practicing specialists. Faculty subspecialists are increasing in numbers, but their trend is toward practi...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1987-09-01 00:00:00
abstract：OBJECTIVE:To evaluate the length of the second stage of labor in relation to increasing maternal prepregnancy body mass index (BMI) among nulliparous parturient women, and to determine whether route of delivery differs among obese, overweight, and normal-weight women reaching the second stage of labor. METHODS:We perf...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,多中心研究
doi：10.1097/AOG.0b013e318236fbd1
更新日期：2011-12-01 00:00:00
abstract：:Over a 3-year period at the Long Beach Women's Hospital, where electronic FHR (fetal heart rate) monitoring was routine, there were 8622 live births, including 41 infants born with major congenital malformations. The neonatal death rate in these malformed infants was 44%; 17 were delivered by cesarean section, 11 of w...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1979-06-01 00:00:00
abstract：OBJECTIVE:To evaluate the outcome of intrauterine growth restriction (IUGR) infants with abnormal pulsatility index of the umbilical artery according to the neonatal birth weight/gestational age standards and the intrauterine growth charts. METHODS:We analyzed 53 pregnancies with severe IUGR classified as group 2 (22 ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0b013e31818bdc7e
更新日期：2008-12-01 00:00:00
abstract：OBJECTIVE:We describe the current state of prevention of neonatal group B streptococcal infections and present recent advances toward the development of a maternal vaccine for prevention of this disease. DATA SOURCES:We used a MEDLINE search of the Index Medicus from 1976-1992 for articles regarding group B streptococ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,评审
doi：
更新日期：1992-08-01 00:00:00
abstract：:A patient undergoing evaluation for primary infertility with regular menses had a normal hysterosalpingogram in the follicular phase and underwent diagnostic laparoscopy the next day, with the finding of a tubal pregnancy. The patient had a negative serum pregnancy test. Although a normal hysterosalpingogram and negat...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1990-03-01 00:00:00
abstract：OBJECTIVE:To estimate if there were dietary or socioeconomic factors associated with preterm premature rupture of membranes (PROM). METHODS:In this case-control study, women with preterm PROM (n = 46) were compared with healthy pregnant women matched for gestational age and vitamin supplementation. Measurements includ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0029-7844(02)02380-3
更新日期：2002-12-01 00:00:00
abstract：:A preterm birth prevention program consisting of risk scoring, intensive weekly observation including cervical examinations, and detailed education about preterm labor signs and symptoms was tested in a predominantly black, indigent population. One thousand high-risk women were randomized to treatment or control group...
journal_title：Obstetrics and gynecology
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1990-06-01 00:00:00
abstract：OBJECTIVE:To assess the predictability and accuracy of a simplified approach--the cough stress test and single-channel cystometry--in the diagnosis of genuine stress incontinence (GSI) by comparing these tests to the more complex multichannel cough urethral pressure profile and urethrocystometry. Conversely, we assesse...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1993-03-01 00:00:00
abstract：:The incidence of diverticular disease of the colon has increased during the course of this century. The management of diverticulitis has changed in many centers from a conservative medical approach to a more aggressive surgical one. The surgical technique has also evolved; primary resection and anastomosis is currentl...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1981-11-01 00:00:00
abstract：OBJECTIVE:To examine current levels, current correlates of, and changes in long-acting reversible contraceptive (LARC) use, including intrauterine devices and implants, among females aged 15-44 years using contraception between 2008-2010 and 2011-2013 with specific attention to associations between race, income, and ag...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000001094
更新日期：2015-11-01 00:00:00
abstract：:Patient care emergencies may occur at any time in any setting, particularly the inpatient setting. It is important that obstetrician-gynecologists prepare themselves by assessing potential emergencies, establishing early warning systems, designating specialized first responders, conducting emergency drills, and debrie...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,实务指引
doi：10.1097/01.AOG.0000444442.04111.c6
更新日期：2014-03-01 00:00:00
abstract：:Thirty-three gravidas with syphilis were monitored with hourly vital signs and examinations for 24 hours after treatment with benzathine penicillin G. Fifteen (45%) of the subjects had a Jarisch-Herxheimer reaction, including all three, 12 of 20 (60%), and none of ten of those with primary, secondary, and latent syphi...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1990-03-01 00:00:00
abstract：OBJECTIVE:To determine whether the overall retention of weight gained during pregnancy and the factors affecting postpartum weight retention differ by race. METHODS:Data from the 1988 National Maternal and Infant Health Survey were analyzed to examine postpartum weight retention of 20 lb or more among 990 black and 11...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1993-05-01 00:00:00
abstract：OBJECTIVE:To explore the relationship between race and depression symptoms among participants in an early pregnancy loss clinical trial. METHODS:We performed a planned secondary analysis of a randomized trial by comparing treatments for medical management of early pregnancy loss. We hypothesized that Black participant...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000004212
更新日期：2021-01-01 00:00:00
abstract：:A double-blind randomized trial of antibiotic prophylaxis was performed with 49 patients undergoing extended pelvic surgery for adenocarcinoma of the endometrium. In this series infections of the Hemovac drain site(s) were most common (8 of 10 infections); only 1 serious infection, pelvic cellulitis, occurred. Short-t...
journal_title：Obstetrics and gynecology
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1982-03-01 00:00:00
abstract：OBJECTIVE:The effect of exogenous hormones on the incidence of breast cancer has been extensively studied. Most studies regarding hormonal contraception have focused on combined oral contraceptives, and there is paucity of literature regarding nonoral and progestin-only contraceptives. The present study analyzed the re...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/01.AOG.0000178754.88912.b9
更新日期：2005-10-01 00:00:00
abstract：:Over an 11-year period (1971 to 1981), 212 urinary conduit surgeries were performed by the Department of Gynecology at the University of Texas, M. D. Anderson Hospital and Tumor Institute at Houston. The urinary diversions were performed as part of the pelvic exenteration operation in 154 patients, for radiation injur...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/00006250-198605000-00015
更新日期：1986-05-01 00:00:00
abstract：:We studied 30 control women and 131 pill users to evaluate effects of birth control pills and clinical factors on hemostasis. When control patients were matched with an equal number of pill users, none of the direct markers of activated hemostasis (fibrinopeptide A, platelet factor 4, and beta thromboglobulin) were in...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1988-04-01 00:00:00
abstract：:In a cohort analysis of Silastic vacuum extractor deliveries, 65% were completed with the vacuum extractor alone, 24% with outlet forceps, 3% with midforceps, and 7% with cesarean section (vacuum extractor-cesarean). Control groups were formed by using the next sequential forceps delivery, spontaneous vaginal delivery...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1986-11-01 00:00:00
abstract：OBJECTIVE:To determine the safety, tolerability, and efficacy of combination gefitinib and methotrexate to treat ectopic pregnancy. METHODS:We performed a phase I, single-arm (nonrandomized), open-label study. Twelve women with ectopic pregnancies were administered methotrexate (50 mg/m, intramuscular) and 250 mg oral...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0b013e3182a14cfb
更新日期：2013-10-01 00:00:00
