Effects of the Enhanced Recovery After Surgery Protocol on Postoperative Recovery, Sleep Quality, and Postpartum Depression in Elective Cesarean Section Patients: A Single-Center, Prospective Study

Elif Keleş Tayfur; Deha Denizhan Keskin

doi:10.18621/eurj.1817709

Effects of the Enhanced Recovery After Surgery Protocol on Postoperative Recovery, Sleep Quality, and Postpartum Depression in Elective Cesarean Section Patients: A Single-Center, Prospective Study

Abstract

Objectives: To assess the effects of the Enhanced Recovery After Surgery–Cesarean Delivery (ERAS-CD) protocol on early postoperative recovery, pain scores, postpartum sleep quality, and postpartum depression in patients undergoing elective cesarean delivery.

Methods: This single-center prospective cohort study involved women with at least one cesarean delivery who underwent planned CD between December 2022 and May 2023. The primary outcome was to reduce hospital stay and morbidity following CD. Secondary outcomes included breastfeeding/formula supplementation status, postoperative pain score, postpartum sleep quality, and predisposition to postpartum depression. The protocol included preoperative oral intake of cherry juice, multimodal analgesia, antiemetic medications, and early ambulation. The number of patients and minimum sample size per group were determined based on power analysis results from previous studies.

Results: A total of 294 patients were included in the study. The ERAS-CD protocol group and the control group were similar in demographic characteristics, body weight, and parity (P>0.05). Postoperative Visual Analog Scale and severe pain scores were lower in all components of the ERAS-CD protocol group (P<0.001). The total score and two subcomponent scores (Sleep duration and Habitual sleep efficiency) of the Pittsburgh Sleep Quality Index were significantly lower in the ERAS-CD group (P=0.005, P=0.004, and P=0.016; respectively). The total score of the Postoperative Recovery Index, as well as the subcomponent scores for bowel symptoms and general symptoms, were significantly lower in the ERAS-CD group (P=0.041, P=0.020, and P=0.045; respectively). Moreover, the Edinburgh Postnatal Depression Scale score and the score indicating predisposition to depression were significantly lower in the ERAS-CD group (P<0.001 for both).

Conclusions: Consistent with the existing literature, the present study demonstrates that the implementation of the ERAS-CD protocol in Cesarean Deliveries has favorable effects on preoperative, intraoperative, and postoperative outcomes. Specifically, the ERAS-CD protocol was shown to reduce postoperative pain, improve postpartum sleep quality, and decrease the predisposition to postpartum depression.

Keywords

Ethical Statement

This study was approved by the Ordu University Clinical Research Ethics Committee (Decision No: 2022/23-263-; date: 25.11.2022). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Written and signed informed consent was obtained from all participants before the study in the presence of their relatives.

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Details

Primary Language

English

Subjects

Obstetrics and Gynaecology

Journal Section

Research Article

Authors

Elif Keleş Tayfur ^*
0000-0003-0456-8210
Türkiye

Deha Denizhan Keskin
0000-0002-6108-7619
Türkiye

Early Pub Date

December 26, 2025

Publication Date

December 26, 2025

Submission Date

November 4, 2025

Acceptance Date

December 20, 2025

Published in Issue

Year 2026 Number: Advanced Online Publication

DOI

https://doi.org/10.18621/eurj.1817709

IZ

https://izlik.org/JA33WC72LF

Cite

RIS / Bibtex

AMA

1.Keleş Tayfur E, Keskin DD. Effects of the Enhanced Recovery After Surgery Protocol on Postoperative Recovery, Sleep Quality, and Postpartum Depression in Elective Cesarean Section Patients: A Single-Center, Prospective Study. Eur Res J. 2025;(Advanced Online Publication):1-11. doi:10.18621/eurj.1817709