Clinical Research Directory

Early Mobilization and No Urinary Catheter After Cesarean for Improved Post Operative Recovery: A Randomized Trial

Sponsor: Bnai Zion Medical Center

Summary

ERAS (Enhanced Recovery After Surgery) is a set of steps used around surgery to help patients recover faster and better. ERAS guidelines have been adopted in several surgical fields, and evidence-based recommendations have recently been developed for cesarean delivery as well. These guidelines address multiple parts of post-operative care, including prevention of nausea and vomiting, pain control, thromboprophylaxis, early mobilization, urinary catheter use, and discharge counseling. Early mobilization is a key element of ERAS, but there is currently limited high-quality evidence about its specific benefits after cesarean delivery. In theory, mobilizing earlier may reduce thromboembolic events, shorten hospitalization, and speed up return of bowel function. Another important ERAS component is avoiding routine urinary catheter use. Evidence suggests that a no-catheter policy can shorten the time to first mobilization, first eating, and first bowel movement, and can reduce overall hospital stay compared with routine catheter use around cesarean delivery. In a randomized controlled trial of 300 women assigned to immediate versus delayed (12-hour) catheter removal after cesarean delivery, immediate removal reduced bacteriuria and urinary symptoms (dysuria, frequency, urgency), and also shortened time to first mobilization and length of stay. A systematic review also found that inserting a catheter before cesarean delivery increases the risk of urinary tract infection without improving surgical ease. A 2014 Cochrane review concluded that routine catheter use increases time to first urination, increases discomfort, delays mobilization, and prolongs hospital stay. The aim of the present study is to compare early mobilization combined with no urinary catheter in women undergoing planned cesarean delivery versus standard perioperative care, to improve recovery after surgery.

Official title: Impact of Promoting Early Mobilization and Eliminating Urinary Catheterization on Post-Cesarean Recovery: A Randomized Control Trial

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