The ARRC III Trial of Advanced Recovery Room Care (ARRC).

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

3000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-04-18

Study Completion Date

2025-12-31

Brief Summary

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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.

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Detailed Description

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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.

Conditions

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Post-Surgical Complication Economic Problems

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Medium risk patients undergoing surgery

Patients undergoing surgery designated as medium risk using NSQIP risk scores

ARRC

Intervention Type OTHER

Eligible for ARRC and managed in ARRC unit

Usual Care

Intervention Type OTHER

Eligible for ARRC but managed elsewhere as no ARRC bed available

Interventions

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ARRC

Eligible for ARRC and managed in ARRC unit

Intervention Type OTHER

Usual Care

Eligible for ARRC but managed elsewhere as no ARRC bed available

Intervention Type OTHER

Eligibility Criteria

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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)