Patient-Reported Outcomes After Enhanced Recovery Protocols for Cesarean Delivery

Abstract

Enhanced Recovery After Cesarean Surgery (ERACS) is a structured perioperative care protocol designed to improve maternal recovery after cesarean delivery. However, evidence focusing on patient-reported outcomes remains limited. This study aimed to compare patient-reported outcomes between mothers undergoing cesarean delivery with ERACS and those receiving conventional perioperative care. This quantitative comparative study included 100 postpartum mothers who underwent cesarean delivery at a Type C hospital in Surabaya, Indonesia, from June 1 to December 31, 2025. Participants were recruited using consecutive sampling and divided into two groups: 50 mothers in the ERACS group and 50 mothers in the non-ERACS group. Patient-reported recovery was measured using the Obstetric Quality of Recovery-11 score at 24 and 48 hours after surgery. Secondary outcomes included pain intensity, early mobilization, oral intake, urinary catheter removal, breastfeeding initiation, maternal satisfaction, readiness for discharge, and length of hospital stay. The ERACS group had higher ObsQoR-11 scores at 24 hours (82.60 ± 8.40 vs. 69.80 ± 9.60) and 48 hours (96.40 ± 6.90 vs. 84.20 ± 8.70) than the non-ERACS group. The ERACS group also reported lower pain scores, earlier mobilization, earlier oral intake, higher breastfeeding initiation, greater satisfaction, better readiness for discharge, and shorter hospital stay. ERACS was associated with better patient-reported recovery and improved early postpartum outcomes after cesarean delivery. These findings support implementing ERACS as a patient-centered perioperative care strategy in routine obstetric surgical services.