Decreasing the post-operative recovery period in cesarean section: A systematic review study

Abstract

This systematic review aims to evaluate the effectiveness of various interventions designed to decrease postoperative recovery time and improve maternal outcomes following cesarean section. The study seeks to provide evidence-based recommendations for optimizing post-cesarean care through a comprehensive analysis of enhanced recovery protocols, pain management strategies, and nursing interventions. A systematic literature search was conducted across five electronic databases (PubMed, Scopus, Web of Science, CINAHL, and Google Scholar) from inception to October 2024, following PRISMA 2020 guidelines. Studies published between 2015 and 2024 were included if they evaluated interventions to improve postoperative recovery following cesarean section. Two reviewers independently screened titles, abstracts, and full-text articles. Quality assessment was performed using the Cochrane Risk of Bias Tool for randomized trials, the Newcastle-Ottawa Scale for cohort studies, and AMSTAR 2 for systematic reviews. Data synthesis was conducted through narrative analysis due to heterogeneity in interventions and outcome measures. Nine studies comprising 3,231 participants were included in the qualitative synthesis. Enhanced Recovery After Surgery (ERAS) protocols demonstrated significant reductions in hospital stay duration (2.8 vs. 3.4 days, p = 0.022) and postoperative complications (8.0% vs. 16.8%, p = 0.031). Multimodal pain management approaches, particularly enhanced transversus abdominis plane (TAP) blocks with dexmedetomidine, showed superior pain control with reduced opioid requirements. Key risk factors for postoperative complications included primary cesarean section (OR 1.66, 95% CI 1.12-2.47), preterm premature rupture of membranes (OR 5.3, 95% CI 2.8-10.1), and intraoperative blood transfusion (OR 3.5, 95% CI 1.9-6.4). Structured, multimodal approaches to post-cesarean care significantly improve maternal outcomes and reduce healthcare resource utilization. ERAS protocols, evidence-based pain management, and early mobilization strategies should be integrated into routine post-cesarean recovery protocols to optimize patient outcomes. Healthcare institutions should implement comprehensive ERAS protocols for cesarean delivery, emphasizing multimodal pain management, early mobilization, and structured nursing care. Risk stratification strategies should be employed to identify high-risk patients requiring enhanced surveillance. The findings support policy development for standardized post-cesarean care protocols and resource allocation for enhanced recovery programs in obstetric settings.