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

Oddy, C; Lowcock, D; Davies, TW; Towey, S; Burnett, M; Davis, A; Davey, G; Green, A; Bools, O; Coulton, M; Lewith, H; Perella, P; Wong, DJN; Pan‐London Perioperative Audit and Research Network Committee; REPACC Study Investigators

doi:10.1111/anae.70057

Perioperative medicine & outcomes

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

AnaesthesiaPublished 10 Nov 2025Retrospective observational study

Main finding · Cancellation of surgeryResultOdds ratio 0.50 95% CI 0.40–0.64

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Authors' conclusion

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.

Study context

Population: Surgical patients referred to enhanced (level 1) or critical care (levels 2–3) at UK centres, September–November 2023
Participants: 5,990 patients · 110 centres

Exposure: Referral to level 1 vs levels 2-3
Level 1n = 3,146
Levels 2-3n = 2,844reference
Outcome: Cancellation of surgery

Methodological detailsUK-wide, multicentre, multilevel regression, cluster analysis, Data collected September–November 2023

UK-wide
Multicentre
Multilevel regression
Cluster analysis
Data collected September–November 2023

Main finding

As reported in the abstract

Odds ratio

0.50

95% CI 0.40–0.64

P < 0.001

Level 1 vs Levels 2-3

OR 0.50 (95% CI 0.40–0.64); P < 0.001

Observational data: associations, not effects.

Further findings

Outcome	← Lower with level 1 ←→ Higher with level 1 →	Estimate	P value
Cancellation due to lack of bed	0.20.5125	OR 0.27 (95% CI 0.19–0.40)	P < 0.001
Duration of hospital stay	0.20.5125	incidence risk ratio 0.58 (95% CI 0.55–0.61)	P < 0.001
	0.20.5125Ratio (log scale)

Centres with a surgical level 1 unit

Centres with a surgical level 1 unit: 70 (63.6%)

Patient characteristics

Enhanced care patients younger, fewer comorbidities, less complex surgery than critical care

Original publication

Structural and organisational impacts of peri‐operative enhanced care services in the UK : a Retrospective Evaluation of Postoperative Alternatives to Critical Care ( REPACC ). Anaesthesia. Published 10 November 2025. doi:10.1111/anae.70057

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