Structural and organisational impacts of peri-operative enhanced care services in the UK: a Retrospective Evaluation of Postoperative Alternatives to Critical Care (REPACC)
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Oddy,Christopher
Lowcock,Dominic
Davies,Thomas W.
Towey,Sarah
Burnett,Mark
Davis,Amanda
Davey,Gareth
Green,Adam
Bools,Olivia
Coulton,Michael
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2025
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INTRODUCTION: The enhanced care model of peri-operative care has evolved to meet increasing surgical demand, aiming to relieve pressure on critical care and prevent unnecessary cancellation of surgery. Despite widespread adoption of these facilities in the UK, no resources currently describe the national landscape of enhanced care or the organisational impacts of their introduction. METHODS: We conducted a UK-wide, retrospective, observational study. At each site, the local structure of enhanced (level 1) and critical care (levels 2-3) services was recorded alongside time-series data describing patient flow and individual details for all referrals to levels 1-3. Multilevel regression was used to explore the relationships between referral to an enhanced care facility and various organisational outcomes. A cluster analysis was performed to group enhanced care units with similar characteristics. RESULTS: Data were collected between September and November 2023. Of 110 participating centres, 70 (63.6%) had a surgical level 1 unit. In total, 5990 patient referrals to levels 1-3 were followed up, of which 3146 (52.5%) were referred to level 1 and 2844 (47.5%) to levels 2-3. Enhanced care patients were younger, with fewer comorbidities, and were undergoing less complex surgery than those referred to critical care. Referral to level 1 rather than levels 2-3 was associated with a reduced likelihood of cancellation (OR 0.50, 95%CI 0.40-0.64, pâ??<â??0.001); cancellation due to a lack of bed (OR 0.27, 95%CI 0.19-0.40, pâ??<â??0.001); and a shorter duration of hospital stay (incidence risk ratio 0.58, 95%CI 0.55-0.61, pâ??<â??0.001). DISCUSSION: Enhanced care services provide a suitable alternative to critical care for high-risk surgical patients in the UK whilst building surgical capacity and system resilience. These facilities are associated with improved organisational outcomes, associations which may reflect both operational efficiency and the lower clinical acuity of the population they serve.; Hospitals in the UK have started using something called â??enhanced careâ?? to help patients who need surgery. This helps make sure there are enough beds in the intensive care unit and stops surgeries from being cancelled when intensive care is full. Even though many hospitals now use enhanced care, no one has yet described how it works across the country or what it means for hospitals. To find out more, a study was done across the UK. The researchers looked back at what had already happened in many hospitals. They collected information about how hospitals organise their care for patients who need different levels of support after surgery. They also collected details about patients sent to these different care levels to see how it affected things like surgery cancellations and time spent in hospital. The study took place from September to November 2023. Out of 110 hospitals, 70 had a special unit for enhanced care after surgery. In total, the researchers followed 5990 patients who were sent to either enhanced care or critical care. About half of the patients went to enhanced care. These patients were usually younger, healthier, and had simpler surgeries than those sent to critical care. Patients who went to enhanced care were less likely to have their surgery cancelled, especially because of a lack of ICU beds. They also stayed in the hospital for a shorter time. In summary, enhanced care is a good option for patients who need some support after surgery but don't need full critical care. It helps hospitals run more smoothly and treat more patients without delays.
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Anaesthesia