Evidence map›Paper›PMID 41208558›Full record

Observational studyAnaesthesia2026

Structural and organisational impacts of peri-operative enhanced care services in the UK: a Retrospective Evaluation of Postoperative Alternatives to Critical Care (REPACC).

Christopher Oddy, Dominic Lowcock, Thomas W Davies, Sarah Towey, Mark Burnett, Amanda Davis, Gareth Davey, Adam Green, Olivia Bools, Michael Coulton and 5 more

Abstract readObservational StudyMulticenter Study
In one paragraph

Observational study in Anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Christopher OddyDepartment of Anaesthesia, Kingston and Richmond NHS Foundation Trust, London, UK.ORCID https://orcid.org/0000-0002-2311-9261
Dominic LowcockDepartment of Anaesthesia, Kingston and Richmond NHS Foundation Trust, London, UK.
Thomas W DaviesDepartment of Anaesthesia, Royal London Hospital, Barts Health NHS Trust, London, UK.
Sarah ToweyDepartment of Anaesthesia, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK.
Mark BurnettDepartment of Anaesthesia, University Hospitals Derby & Burton NHS Foundation Trust, Derby, UK.
Amanda DavisDepartment of Research and Innovation, Kingston and Richmond NHS Foundation Trust, London, UK.
Gareth DaveyDepartment of Anaesthesia, Kingston and Richmond NHS Foundation Trust, London, UK.
Adam GreenDepartment of Anaesthesia, St George's University Hospitals NHS Foundation Trust, London, UK.
Olivia BoolsDepartment of Anaesthesia, Kingston and Richmond NHS Foundation Trust, London, UK.
Michael CoultonDepartment of Anaesthesia, Swansea Bay University Health Board, Swansea, UK.
Henry LewithDepartment of Anaesthesia, Kingston and Richmond NHS Foundation Trust, London, UK.
Paolo PerellaDepartment of Anaesthesia, Kingston and Richmond NHS Foundation Trust, London, UK.
Danny J N WongDepartment of Anaesthesiology, Singapore General Hospital, Singapore.
Pan‐London Perioperative Audit and Research Network Committee
REPACC Study Investigators

Funding

MPS Foundation TMPSF2024001
6 · The paper itself

Abstract

introductionThe 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.

methodsWe 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.

resultsData 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, p < 0.001); cancellation due to a lack of bed (OR 0.27, 95%CI 0.19-0.40, p < 0.001); and a shorter duration of hospital stay (incidence risk ratio 0.58, 95%CI 0.55-0.61, p < 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.

Indexed as

Critical CarePerioperative CarePostoperative CareAdultAgedFemaleHumansLength of StayMaleMiddle AgedReferral and ConsultationRetrospective StudiesUnited Kingdomcancellationcritical careenhanced careintermediate carepostoperative care

Identifiers

PMID41208558
PMCPMC12973336

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.