Expert Consensus Regarding Core Outcomes for Enhanced Recovery after Cesarean Delivery Studies: A Delphi Study

Pervez Sultan, Ron George, Carolyn F. Weiniger, K. El-Boghdadly, Perman Pandal, Brendan Carvalho, Jessica R. Ansari, Dan Benhamou, Moris Baluku, Peter S. Bernstein, Laurent A. Bollag, Sarah J. Bowden, Emily Fay, Ashraf S. Habib, Sunil Halder, Ruth Landau, Grace Lim, Vincent Liu, Colleen Moreno, Gregg S. NelsonMark F. Powell, Borislava Pujic, Nadir Sharawi, Natasha Singh, Roger Smith, Emily Stockert, Ellile Sultan, Mohamed Tiouririne, R. Douglas Wilson, Ian J. Wrench, Romy Yun, Mark Zakowski

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


Background: Heterogeneity among reported outcomes from enhanced recovery after cesarean delivery impact studies is high. This study aimed to develop a standardized enhanced recovery core outcome set for use in future enhanced recovery after cesarean delivery studies. Methods: An international consensus study involving physicians, patients, and a director of midwifery and nursing services was conducted using a three-round modified Delphi approach (two rounds of electronic questionnaires and a third-round e-discussion) to produce the core outcome set. An initial list of outcomes was based on a previously published systematic review. Consensus was obtained for the final core outcome set, including definitions for key terms and preferred units of measurement. Strong consensus was defined as 70% or greater agreement and weak consensus as 50 to 69% agreement. Of the 64 stakeholders who were approached, 32 agreed to participate. All 32, 31, and 26 stakeholders completed Rounds 1, 2 and 3, respectively. Results: The number of outcomes in the final core outcome set was reduced from 98 to 15. Strong consensus (70% or greater stakeholder agreement) was achieved for 15 outcomes. The core outcome set included length of hospital stay; compliance with enhanced recovery protocol; maternal morbidity (hospital re-admissions or unplanned consultations); provision of optimal analgesia (maternal satisfaction, compliance with analgesia, opioid consumption or requirement and incidence of nausea or vomiting); fasting times; breastfeeding success; and times to mobilization and urinary catheter removal. The Obstetric Quality of Recovery-10 item composite measure was also included in the final core outcome set. Areas identified as requiring further research included readiness for discharge and analysis of cost savings. Conclusions: Results from an international consensus to develop a core outcome set for enhanced recovery after cesarean delivery are presented. These are outcomes that could be considered when designing future enhanced recovery studies.

Original languageEnglish (US)
Pages (from-to)201-211
Number of pages11
Issue number2
StatePublished - Aug 1 2022
Externally publishedYes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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