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Objective  The aim of this study is to assess the effect of a resident-led enhanced recovery after surgery (ERAS) protocol for scheduled prelabor cesarean deliveries on hospital length of stay and postpartum opioid consumption. Study Design  This retrospective cohort study included patients who underwent scheduled prelabor cesarean deliveries before and after implementation of an ERAS protocol at a single academic tertiary care institution. The primary outcome was length of stay following cesarean delivery. Secondary outcomes included protocol adherence, inpatient opioid consumption, and patient-centered outcomes. The protocol included multimodal analgesia and antiemetic medications, expedited urinary catheter removal, early discontinuation of maintenance intravenous fluids, and early ambulation. Results  A total of 250 patients were included in the study: 122 in the pre-ERAS cohort and 128 in the post-ERAS cohort. There were no differences in baseline demographics, medical comorbidities, or cesarean delivery characteristics between the two groups. Following protocol implementation, hospital length of stay decreased by an average of 7.9 hours (pre-ERAS 82.1 vs. post-ERAS 74.2, p  < 0.001). There was 89.8% adherence to the entire protocol as written. Opioid consumption decreased by an average of 36.5 mg of oxycodone per patient, with no significant differences in pain scores from postoperative day 1 to postoperative day 4 (all p  > 0.05). Conclusion  A resident-driven quality improvement project was associated with decreased length of hospital stay, decreased opioid consumption, and unchanged visual analog pain scores at the time of hospital discharge. Implementation of this ERAS protocol is feasible and effective. Key Points Enhanced recovery after surgery (ERAS) principles can be effectively applied to cesarean delivery with excellent protocol adherence. Patients who participated in the ERAS pathway had significant decreases in hospital length of stay and opioid pain medication consumption with unchanged visual analog pain scores postoperative days 1 through 4. Resident-driven quality improvement projects can make a substantial impact in patient care for both process measures (e.g., protocol adherence) and outcome measures (e.g., opioid use). [ABSTRACT FROM AUTHOR]

Background: Weight retention after pregnancy is a concern for adolescents who may be entering adulthood at unhealthy weights. Methods: We studied associations between each of three measures: prepregnancy body mass index (BMI), gestational weight gain (GWG), and postpregnancy BMI in a longitudinal follow-up of an adolescent pregnancy study cohort. BMI and GWG were compared using t-tests and linear regression. Results: Among 91 adolescents, mean prepregnancy BMI was 24.6 [standard deviation (SD) 5.7] and mean GWG was 15.5 kg [SD 6.3]. Overall, prepregnancy BMI was not significantly related to GWG (p = 0.145). Among 42 teens with postpregnancy weight data, within 4 years of their first delivery, mean postpregnancy BMI was 26.3 [SD 5.0] with an average BMI increase of 2.0 points [SD 5.1] (p = 0.013) from prepregnancy. Within 4 years of their first delivery, 45% of teens moved to a higher BMI category. For every 4.5 kg (10 lb) increase in GWG, BMI within 4 years increased on average by 1.6 points (p = 0.006). The association persisted (1.0 points, p = 0.049) after controlling for prepregnancy BMI. Conclusions: Teens experienced an increase in BMI from prepregnancy to within 4 years after their first delivery, and this increase was related to GWG. Adolescent mothers are at risk for developing and maintaining unhealthy BMI after pregnancy, which may be amplified by GWG. [ABSTRACT FROM AUTHOR]