Meta-Analysis: Effectiveness of Enhanced Recovery After Caesarean Surgery (ERACS) on Length of Stay (LoS)
DOI:
https://doi.org/10.26555/eshr.v8i1.14767Keywords:
Enhanced recovery after caesarean surgery, Length of stay, Meta-analysisAbstract
Background: Enhanced Recovery After Caesarean Surgery (ERACS) has evolved as a comprehensive perioperative care protocol to optimise patient recovery and reduce length of hospitalisation. Although individual studies show promising results, there has been no comprehensive meta-analysis of the effectiveness of ERACS on length of stay with a homogeneous methodology. This study aims to analyse the effectiveness of the ERACS protocol compared to conventional treatment on the length of hospitalisation through a systematic review and meta-analysis
Method: A Systematic review was conducted following the PRISMA 2020 guidelines for studies that compared ERACS with conventional treatment in the section caesarea. Meta-analysis was performed using a random-effects model with the Jamovi software ESCI package. Heterogeneity was assessed using I² statistics, and sensitivity analysis was performed to test the robustness of the results.
Results: Meta-analysis of 6 studies with a total of 820 subjects showed that the ERACS protocol significantly reduced the length of hospitalisation with a weighted mean difference of -21.6 hours (95% CI: -28.3 to -14.9, p = 0.001). Despite the high heterogeneity (I² = 99.5%), all studies showed consistent directional effects in favour of ERACS with a p-value of < 0.05 in all individual studies.
Conclusion: Implementing the ERACS protocol provides significant clinical benefits in reducing the length of hospitalisation by almost 1 day compared to conventional treatment, with important implications for healthcare efficiency and cost-effectiveness.
References
WHO. Caesarean section rates continue to rise, amid growing inequalities in access [Internet]. 2021 [cited 2026 Feb 6]. Available from: https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access
Gupta S, Gupta A, Baghel AS, Sharma K, Choudhary S, Choudhary V. Enhanced Recovery after Cesarean Protocol versus Traditional Protocol in Elective Cesarean Section: A Prospective Observational Study. Journal of Obstetric Anaesthesia and Critical Care. 2022;12(1):28–33. doi: 10.4103/joacc.joacc_16_22
Wilson RD, Caughey AB, Wood SL, Macones GA, Wrench IJ, Chb MB, et al. Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery (ERAS) Society Recommendations (Part 1) R. The American Journal of Obstetrics & Gynecology. 2018;(Part 1). doi: 10.1016/j.ajog.2018.09.015
Macones GA, Caughey AB, Wood SL, Wrench IJ, Chb MB, Huang J, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). The American Journal of Obstetrics & Gynecology. 2019;221(3):247.e1-247.e9. doi: 10.1016/j.ajog.2019.04.012
Baluku M, Bajunirwe F. A Randomized Controlled Trial of Enhanced Recovery After. 2020;(June). doi: 10.1213/ANE.0000000000004495.
Mundhra R, Kumar D, Bahadur A, Kumar A, Kumar R. European Journal of Obstetrics & Gynecology and Reproductive Biology: X Effect of Enhanced Recovery after Surgery ( ERAS) protocol on maternal outcomes following emergency caesarean delivery: A randomized. Eur J Obstet Gynecol Reprod Biol X. 2024;22(February):100295. doi: 10.1016/j.eurox.2024.100295
Sravani P, Pravalina R, Sahoo G, Pati BK. Comparative study between eras protocol and conventional perioperative care in elective cesarean section patients in a tertiary care centre of eastern India. 2023;21(3):94–106. doi: 10.55131/jphd/2023/210308
Özdemir MG, Gunaydin B, Bayram M. Effect of enhanced recovery after surgery (ERAS) protocol on maternal and fetal outcomes following elective cesarean section: an observational trial. 2025;3. doi: 10.1186/s12884-025-07583-3
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372. doi: 10.1136/bmj.n71
Falagas ME, Pitsouni EI, Malietzis GA, Pappas G. Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses. The FASEB Journal. 2008;22:338–42. doi: 10.1096/fj.07-9492LSF
Cumming G, Calin-Jageman R. Introduction to the New Statistics: Estimation, Open Science, and Beyond. Introduction to the New Statistics: Estimation, Open Science, and Beyond. 2016. 1–564 p. doi: 10.4324/9781032689470
Borenstein M, Hedges L V, Higgins JPT, Rothstein HR. Introduction to Meta-Analysis. United Kingdom: A John Wiley and Son; 2011.
Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. 2002;1558:1539–58. DOI: 10.1002/sim.1186
Sordia-pineyro MO, Villegas-cruz C, Hernandez-bazaldua M, Pineyro-cantu A, Gaston-locsin T, Sordia-hernandez LH, et al. Effect of the implementation of an enhanced recovery after surgery protocol (ERAS) in patients undergoing an elective cesarean section. 2023;94(2):141–5. DOI: 10.5603/GP.a2023.0003
Kalpana L, Sharma N. Implementation of Enhanced Recovery After Surgery (Eras) Guidelines in Elective Cesarean Sections. J Neonatal Surg. 2025;14(25):69–79.
Sultan P, Sadovnikoff N, Gibson R, Gizzo S, Boeri C, Carvalho B. Impact of enhanced recovery after cesarean delivery on maternal outcomes: A systematic review and meta-analysis. Anaesth Crit Care Pain Med. 2021;40(5). doi: 10.1016/j.accpm.2021.100935
Wyatt S, Silitonga PII, Febriani E, Long Q. Socioeconomic, geographic and health system factors associated with rising C-section rate in Indonesia: A cross-sectional study using the Indonesian demographic and health surveys from 1998 to 2017. BMJ Open. 2021;11(5). doi: 10.1136/bmjopen-2020-045592
Grasch JL, Rojas JC, Sharifi M, McLaughlin MM, Bhamidipalli SS, Haas DM. Impact of Enhanced Recovery After Surgery pathway for cesarean delivery on postoperative pain. AJOG Global Reports. 2023;3(1):1–9. doi: 10.1016/j.xagr.2023.100169
Pinho B, Costa A. Impact of enhanced recovery after surgery (ERAS) guidelines implementation in cesarean delivery: A systematic review and meta-analysis. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2024;292(April 2023):201–9. doi: 10.1016/j.ejogrb.2023.11.028
Tazreean R, Nelson G, Twomey R. Early mobilization in enhanced recovery after surgery pathways: Current evidence and recent advancements. J Comp Eff Res. 2022;11(2):121–9. doi: 10.2217/cer-2021-0258
Oktavia E, Wahyoedi S, Gunardi WD. Implementation of ERACS to Optimize High-Demand Delivery Services at a Secondary Public Hospital in The Jakarta Region. Indonesian Journal of Clinical Pharmacy. 2023;12(1):20–30. doi: https://doi.org/10.15416/ijcp.2023.12.1.20
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