Post-cesarean rehabilitation practices without an ERAS protocol in two hospitals in Kinshasa: A prospective descriptive study

Introduction

Post-cesarean rehabilitation aims to promote functional recovery after surgery. In low-resource settings, these practices often remain conservative, particularly in the absence of formal Enhanced Recovery After Surgery (ERAS) protocols.

Purpose

To describe post-cesarean rehabilitation practices in two hospitals in Kinshasa without an ERAS protocol, in order to provide baseline data for future strategies aimed at improving postoperative care.

Methods

This prospective descriptive study was conducted from December 2024 to February 2025 at the Kinshasa University Clinics and Ngaliema Clinic. Women aged ≥ 18 years, classified as American Society of Anesthesiologists (ASA) physical status II, and who underwent cesarean delivery were included. Patients with perioperative or postoperative complications likely to prolong hospitalization were excluded. A consecutive exhaustive sampling strategy was used throughout the study period. Data were collected through direct observation and structured interviews using a standardized data collection form. Statistical analysis was descriptive.

Results

A total of 204 patients were included in the analysis. The mean age was 29.9 ± 5.8 years, and 62.3% of cesarean deliveries were performed as emergencies. Spinal anesthesia was used in 98.5% of patients, with limited use of intrathecal morphine. Prevention of postoperative nausea and vomiting using dexamethasone was performed in 5.4% of cases. Mean times to postoperative recovery milestones were 11.7 ± 5.3 hours for first oral fluid intake, 40.5 ± 12.8 hours for the first meal, 25.1 ± 10.6 hours for urinary catheter removal, 62.9 ± 28.5 hours for intravenous catheter removal, and 21.4 ± 9.0 hours for first mobilization. At 24 hours postoperatively, 78.9% of patients reported moderate to severe pain (numerical rating scale [NRS] > 3). Indicators of mother–infant bonding, such as infant carrying, were infrequent. The mean length of hospital stay was 5.1 ± 0.7 days.

Conclusion

These findings indicate underutilization of several ERAS components, particularly early feeding, early mobilization, and optimized multimodal analgesia. This highlights opportunities for the progressive implementation of ERAS strategies adapted to the local context.