Overview
A postoperative high-acuity model of care (ARRC) has been shown, in a prospective cohort study of approximately 850 patients, to produce a marked improvement in patient and hospital outcomes, and hospital costs, in medium risk patients (Ludbrook G et al., JAMA Surgery 2023).
The goal of this observational study is to examine the outcomes after non-cardiac surgery of a larger group of medium risk patients receiving different forms of care -ARRC and usual ward care. The main questions it aims to answer are:
what are the outcomes for patients and hospital after the different forms of care, who receives benefit from high acuity care, what underlies the improved outcomes seen with high acuity care.
Description
Demand for essential surgery is growing, yet we face an increasingly complex casemix and budget challenges. New paradigms to deliver high value care are essential.
Advanced Recovery Room Care (ARRC) is a model of care which, at RAH, has been shown to provide substantial improvements in patient outcomes, hospital utilisation, and costs of care. Specifically, it showed when compared to usual ward care: improved Days at Home after Surgery (primary outcome), decreased in-hospital complications, and decreased mortality at 1, 3 and 12 months. This model was cost-effective compared to usual ward care: ICER of approximately -$250 per DAH
It is essential to collect high quality data on this model relevant to consumers and hospitals, in order to:
- provide a robust mechanism to ensure outcomes are maintained, and ideally improved, within our institution
- provide a mechanism to potentially allow benchmarking in the future, across institutions
- better identify which surgical subgroups receive benefit from ARRC
- provide a resource to generate and test hypotheses as to how these benefits are achieved.
To that end, the ARRC II study database is to be refined to function in essence as an ongoing registry.
This will be initially piloted at RAH, the subject of this study.
Eligibility
Inclusion Criteria:
- Scheduled for elective or unplanned surgery
- Scheduled to stay in hospital at least one night after surgery
- 30-day mortality of 0.5% to 8% by the US National Safety and Quality Improvement Program risk score (NSQIP)
Exclusion Criteria:
- Undergoing cardiac surgery
- Scheduled for postoperative Intensive Care Unit management