The ARRC III Trial of Advanced Recovery Room Care (ARRC). A Pilot Registry at RAH

Study Overview
=================
Brief Summary
-----------------
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 (in press). 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.

Detailed 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.

Official Title
-----------------
The ARRC III Trial of Advanced Recovery Room Care (ARRC). A Pilot Registry at RAH

Conditions
-----------------
Post-Surgical Complication, Economic Problems

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Scheduled for elective or unplanned surgery at Royal Adelaide Hospital 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

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------
What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Days at Home after surgery | number of days spent at usual place of residence within 90 days after surgery | 90 days after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| in-hospital complications | medical emergency response level complications | out to 10 days after surgery | 
| mortality | mortality out to 1 year after surgery | 12 months after surgery | 
| cost-effectiveness | cost per Day at Home improvement compared to usual care - Incremental cost-effectiveness ratio | 90 days after surgery | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
postoperative complications, safety, health economics, quality of recovery after surgery, surgery, anaesthesia