May 4, 2023

Study: Advanced recovery room care results in fewer complications, shorter length of stay in noncardiac surgical patients

Editor's Note

A study led by researchers at Central Adelaide Local Health Network in Adelaide, Australia, finds using a highly structured advanced recovery room care (ARRC) model leads to greater detection and management of postoperative complications and shorter length of stay in medium-risk noncardiac patients.

The study builds on a recent feasibility trial examining high-acuity postoperative care through the ARRC model, a highly structured and protocol driven care model that extends the traditional postanesthesia care unit (PACU) care up to 24 hours post-surgery. It provides a higher nurse-to-patient ratio of 1:2, on-site anesthesia-experienced physicians, continuous monitoring, and capacity for a broad range of intravenous fluids and medicine.

The observational cohort study included 854 medium-risk, adult noncardiac surgical patients who were scheduled for at least two postoperative nights between March and November 2021. 452 patients were allocated to the ARRC model, while 419 received traditional PACU care and transitioned to the surgical ward. Days at home at 30-days, complications, and mortality were measured.

Inpatient medical emergencies. Medical emergencies were detected more often in the ARRC environment in the first day and night after surgery than on the ward where patients had usually been managed, and physicians seemed more effective at addressing complications. A higher proportion of patients were ready for ward transfer by the morning than in the feasibility trial.

The need for ICU transfer on day one decreased to 1.3% from the feasibility trial figure of about 10%. After discharge, the incidence of emergencies was lower in patients who received ARRC out to post-operative day 9.

Length of stay. Patients who received ARRC averaged two more days at home 30-days post-surgery than those with traditional PACU care. Mortality at 30- and 90-days post-surgery was 50% lower in the ARRC patient group.

“Follow-up longer than 30 days after surgery may yield important information on patient outcomes relevant to in-hospital care. A larger study is required to explore differences in the secondary outcomes,” the authors conclude.


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