Recommended Interventions for Enhanced Recovery After Cesarean Delivery in the United States: a Delphi study

BackgroundExisting enhanced recovery after cesarean delivery (ERAC) professional society recommendations lack intersociety collaboration, multidisciplinary expert input and involvement of patient stakeholders. This initiative aimed to develop a multidisciplinary set of ERAC interventions endorsed by relevant US professional societies and patient representatives. MethodsThis American Society of Anesthesiologists (ASA) and American College of Obstetricians and Gynecologists (ACOG) led initiative received IRB approval from Stanford University. In total 19 stakeholders were invited to participate in this Delphi study, including 13 representatives from 8 US professional societies (American Society of Anesthesiologists (ASA - 1 representative), Society for Obstetric Anesthesia and Perinatology (SOAP - 2), American College of Obstetricians and Gynecologists (ACOG - 4), Society for Maternal Fetal Medicine (SMFM - 1), Society of OBGYN Hospitalists (SOGH - 1), Enhanced Recovery After Surgery Society (ERAS Society - 1), Association of Womens Health Obstetric and Neonatal Nurses ((AWHONN -2), American Association of Nurse Anesthesiology (AANA - 1), a physical therapist, a lactation expert and 4 patient representatives from diverse backgrounds. A three-round modified Delphi approach was conducted (2 rounds of electronic questionnaires and a 3rdround of e-discussion), to produce the final set of ERAC recommendations. An initial list of 70 interventions was compiled based on a previously published systematic review of ERAC studies and professional society guidelines/recommendations (ERAS Society, SOAP, and Healthcare Canada). Consensus was obtained for the final list of interventions, with strong consensus defined as [≥]70% agreement and weak consensus as 50-69% agreement. ResultsAll professional societies that were approached provided content-expert stakeholders to participate, and all stakeholders completed all rounds of the Delphi process. A final set of 32 interventions (6 preoperative, 13 intraoperative and 13 postoperative) achieved strong consensus. ConclusionsThis US intersociety and multidisciplinary Delphi study resulted in a list of ERAC interventions, which should be considered when implementing ERAC within US labor and delivery units.