{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:15:17Z","timestamp":1787004917823,"version":"build-2736575974"},"reference-count":42,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:p>Objective\u2003This study aimed to evaluate whether enhanced recovery after cesarean (ERAC) pathways reduces inpatient and outpatient opioid use, pain scores and improves the indicators of postoperative recovery.<\/jats:p>\n                  <jats:p>Study Design\u2003This is a prospective, longitudinal, quality improvement study of all patients older than 18 undergoing an uncomplicated cesarean delivery (CD) at an academic medical center. We excluded complicated CD, patients with chronic pain disorders, chronic opioid use, acute postpartum depression, or mothers whose neonate demised before their discharge. Lastly, we excluded non-English- and non-Spanish-speaking patients. Our study compared patient outcomes before (pre-ERAC) and after (post-ERAC) implementation of ERAC pathways. Primary outcomes were inpatient morphine milligram equivalent (MME) use and the patient's delta pain scores. Secondary outcomes were outpatient MME prescriptions and indicators of postoperative recovery (time to feeding, ambulation, and hospital discharge).<\/jats:p>\n                  <jats:p>Results\u2003Of 308 patients undergoing CD from October 2019 to September 2020, 196 were enrolled in the pre-ERAC cohort and 112 in the post-ERAC cohort. Patients in the pre-ERAC cohort were more likely to require opioids in the postoperative period compared with the post-ERAC cohort (81.6 vs. 64.3%, p\u2009&lt;\u20090.001). Likewise, there was a higher use of MME per stay in the pre-ERAC cohort (30 [20\u201349] vs. 16.8 MME [11.2\u201333.9], p\u2009&lt;\u20090.001). There was also a higher number of patients who required prescribed opioids at the time of discharge (98 vs. 86.6%, p\u2009&lt;\u20090.001) as well as in the amount of MMEs prescribed (150 [150\u2013225] vs. 150 MME [112\u2013150], p\u2009&lt;\u20090.001; different shape of distribution). Furthermore, the patients in the pre-ERAC cohort had higher delta pain scores (3.3 [2.3\u20134.7] vs. 2.2 [1.3\u20133.7], p\u2009&lt;\u20090.001).<\/jats:p>\n                  <jats:p>Conclusion\u2003Our study has illustrated that our ERAC pathways were associated with reduced inpatient opioid use, outpatient opioid use, patient-reported pain scores, and improved indicators of postoperative recovery.<\/jats:p>\n                  <jats:p>Key Points<\/jats:p>","DOI":"10.1055\/s-0043-1775560","type":"journal-article","created":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T18:48:03Z","timestamp":1695667683000},"page":"229-240","source":"Crossref","is-referenced-by-count":3,"title":["A Prospective Longitudinal Quality Initiative toward Improved Enhanced Recovery after Cesarean Pathways"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1558-702X","authenticated-orcid":false,"given":"Liviu","family":"Cojocaru","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal-Fetal Medicine, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Alton","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland Medical Center, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Autusa","family":"Pahlavan","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Coghlan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunuk","family":"Seung","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Trilling","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, University of Pittsburg School of Medicine, Pittsburg, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavani S.","family":"Kodali","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Division of Obstetric Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5245-5934","authenticated-orcid":false,"given":"Sarah","family":"Crimmins","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal-Fetal Medicine, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine R.","family":"Goetzinger","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal-Fetal Medicine, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,9,25]]},"reference":[{"key":"ref1","volume-title":"Most Frequent Procedures Performed in U.S. Hospitals, 2010: 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