Enhanced recovery after surgery for cesarean delivery: a systematic review and meta-analysis of randomized trials with trial sequential analysis.

Authors

Tauãna Terra Cordeiro de Oliveira, Vanessa Tapioca, Eduardo Pereira, Bruna Ferreira, Tamiris Soares, Sara Amaral, Maria Luisa Assis, Gabriel Carvalho, Julio S Curi, Kamal Kumar

Published in

Brazilian journal of anesthesiology (Elsevier). Pages 844817. Aug 14, 2026. Epub Aug 14, 2026.

Abstract

Enhanced Recovery After Surgery (ERAS) protocols have improved perioperative care across multiple surgical specialties. In obstetrics, ERAS pathways for cesarean delivery have been increasingly adopted; however, their comparative effectiveness versus standard care remains uncertain. Therefore, we conducted a systematic review and meta-analysis with trial sequential analysis to compare ERAS protocols with standard perioperative care in cesarean delivery.
We systematically searched MEDLINE, Embase, Web of Science, and Cochrane databases for Randomized Clinical Trials (RCTs) comparing ERAS and standard care in parturient undergoing cesarean delivery. Statistical analyses were performed using R software (version 4.2.2). We conducted subgroup analyses based on cesarean category (elective vs. emergency) and national income level. A Trial Sequential Analysis (TSA) was also performed.
We included 13 RCTs comprising 1,809 parturient. ERAS was associated with a significant reduction in hospital Length of Stay (LOS) compared with standard care (MD = -17.05-hours, 95% CI -25.08 to -9.02 hours, I² = 98.2%, n = 1,128, p < 0.01), with similar effects across elective and emergency cesarean deliveries. Greater reductions were observed in low- and middle-income countries, whereas no significant difference was identified in upper-middle-income settings, albeit formal subgroup test was not significant. ERAS was associated with lower postoperative pain at 24- and 48 hours, reduced wound infection, and higher maternal satisfaction, with no differences in readmission and postoperative nausea and vomiting. TSA suggested that the accrued sample size was adequate for hospital LOS; however, this should be interpreted cautiously given the substantial clinical and methodological heterogeneity.
This systematic review and meta-analysis suggest that ERAS protocols may be associated with reduced hospital stay and improved maternal recovery after cesarean delivery.

PMID:
42600936
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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