Advanced Recovery Room Care - a trial of enhanced care after surgery for patients at medium risk of complications after surgery

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Moderate-risk surgical patients appear to have a high incidence of early, often undetected, serious postoperative complications. This affects patients’ wellbeing and produces a high rate of unplanned postoperative hospital re-admissions. This is also costly, and patients unnecessarily fill inpatient beds. A trial of a new model of enhanced care after surgery (Advanced Recovery Room Care, ‘ARRC’) demonstrated that complications were quickly identified and expertly addressed. Re-admission days appeared to be decreased by 80%. Business and economic analysis showed (i) patients could expect 3 extra days at home, (ii) 4000 bed days could be freed annually, and (iii) better care at lesser cost (technically, ICER of -$600/day at home). Freeing hospital beds, and rapid cost savings, are especially important with current economic challenges with Covid. This trial re-introduces ARRC for Orthopaedic, Colorectal, Gynae-Oncology and Neurosurgery, then other specialties, to formally test the apparent benefits. It adds better risk assessment and triage tools. Datasets from patient progress and vital signs are used to improve patient risk stratification and triage at defined timepoints before, during, and after surgery, allowing better and earlier identification of patients (not) needing ongoing ARRC, reducing costs further. A Markov cost-effectiveness model provides the platform for cost effectiveness outcomes (Days at Home V Cost). This work addresses all Principles from a recent national summit on postoperative complications - https://thehiddenpandemic.com

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