Research & InnovationEPOC Outcomes Registry
The EPOC Outcomes Registry (EOR) reports outcomes and patterns of practice in EPOC units. It helps us measure performance, compare results across centres, and improve the standard of postoperative care.
Why data matters
Data collected across EPOC units serve three purposes:
Comparing outcomes and costs against other models of care
Generating and testing new ideas and initiatives
Tracking performance over time and across contributing centres
Two recent systematic reviews examined published outcomes for EPOC-type units. Both found consistent signals of improved patient and hospital outcomes compared to ward care and surgical high-dependency units (HDUs). The evidence base is still building — which is why the Registry exists.
References
Schockaert B.R., van Bruchem RM, Engel MF, Stolker RJ, van Lier F, Hoeks SE. Outcomes following extended postoperative recovery unit admission in noncardiac surgery: A systematic review and meta-analysis. Eur J Anaesthesiol, 2025. 42(5): p. 407–418.
Tran L., Stern C, Harford P, Ludbrook G, Whitehorn A. Effectiveness and Safety of Enhanced Postoperative Care Units for Noncardiac, Non-Neurological Surgery: A Systematic Review. A A Pract, 2025. 19(8): p. e02008.
Understanding which patients benefit most
EPOC units improve outcomes — but in an era of constrained resources, knowing which patients benefit most is just as important as knowing that they benefit at all. In most EPOC units with published data, patient selection is based on clinical judgement. There is a growing need to replace or supplement that judgement with evidence-based criteria.
0.7–5%
NSQIP-predicted 30-day mortality for medium-risk patients in ARRC II
18 mo
Mortality benefit observed out to 18 months after EPOC care
3,000+
Patients in the existing RAH ARRC database
The ARRC II trial demonstrated a range of benefits for medium-risk patients — defined as those with an NSQIP-predicted 30-day mortality of 0.7–5%. These include fewer major complications, more days at home after surgery, and lower mortality at up to 18 months.
Building on this, the ongoing ARRC III study uses a prospective observational registry to collect data from patients considered eligible for ARRC care. The aim is to identify the patient and surgical factors most strongly associated with benefit — creating a practical evidence base to guide admission decisions and optimise postoperative resource use.
Several centres are now contributing data to this analysis. Early results from the Royal Adelaide Hospital suggest this approach can produce clear, usable rules to guide EPOC admission.
References
Lloyd C., et al. Incidence of early major adverse events after surgery in moderate-risk patients. Br J Anaesth, 2020. 124(1): p. e9–e10.
Ludbrook G., et al. Outcomes of Postoperative Overnight High-Acuity Care in Medium-Risk Patients. JAMA Surg, 2023. 158(7): p. 701–708.
Ludbrook G., et al. Delayed Mortality in Patients Receiving Postoperative High-Acuity Care. JAMA Surg, 2025. 160(3): p. 356–357.
Argalious M.Y. Postoperative intensive care unit admissions: leveraging science to strike the right balance. Br J Anaesth, 2026. 136(1): p. 5–8.
Quality indicators
Most EPOC outcome tracking happens within individual institutions and is rarely shared. A common set of quality measures would change that. We are working with the Perioperative Quality Initiative (POQI) to develop formal quality indicators for EPOC units. These will fall into two categories:
Outcome measuresWhat changed for patients
Measures based on published evidence of improvement — for example, rates of major complications and hospital utilisation
Process MeasuresHow outcomes improve
Measures that reflect the mechanisms behind improvement — for example, compliance with ERAS and DrEaMing principles.
The pilot registry
We have developed a dataset to launch a shared pilot registry. It is the first step toward systematic, multi-centre data collection.
The dataset identifies patient and surgical factors associated with EPOC outcomes, along with endpoints that reflect the real impact of EPOC care. Data points are graded in three tiers:
EssentialA core set of key factors and simple outcomes. Required from all participating centres.
ImportantAdditional detail that enables deeper analysis across centres.
DiscretionaryAdvanced endpoints — including Days at Home (DAH), collected via a brief 30-day follow-up call.
Note: Many data points are already in NSQIP. Complete the National Surgical Quality Improvement Program (NSQIP) risk assessment tool online and download the output — this significantly reduces the data entry burden for your centre.
| Phase | Data point | Format / values | Priority | Source |
|---|---|---|---|---|
| Preop | Age | Years | Essential | NSQIP |
| Preop | Gender | M / F | Essential | NSQIP |
| Preop | Surgery | Name of operation | Essential | NSQIP |
| Preop | Surgery specialty | — | Essential | NSQIP |
| Preop | Emergency case | Y / N | Essential | NSQIP |
| Preop | ASA physical status | 1 to 5 | Essential | NSQIP |
| Preop | Preoperative functional status | Dependent / Partially dependent / Independent | Essential | NSQIP |
| Preop | Immunosuppressants | Y / N | Essential | NSQIP |
| Preop | Ascites | Y / N | Essential | NSQIP |
| Preop | Systemic sepsis | Y / N | Essential | NSQIP |
| Preop | Ventilated | Y / N | Essential | NSQIP |
| Preop | Disseminated cancer | Y / N | Essential | NSQIP |
| Preop | Diabetes | Oral / Insulin | Essential | NSQIP |
| Preop | Hypertension requiring treatment | Y / N | Essential | NSQIP |
| Preop | Congestive cardiac failure in last 30 days | Y / N | Essential | NSQIP |
| Preop | On supplemental oxygen | Y / N | Essential | NSQIP |
| Preop | Smoker in last 12 months | Y / N | Essential | NSQIP |
| Preop | Severe COPD (functionally impaired; not asthma) | Y / N | Essential | NSQIP |
| Preop | Dialysis | Y / N | Essential | NSQIP |
| Preop | Acute kidney injury stage 2/3 | Y / N | Essential | NSQIP |
| Preop | Weight / BMI | Numeric | Essential | NSQIP |
| Preop | eGFR (kidney function) | Numeric | Essential | — |
| Preop | NSQIP predicted 30-day mortality | Numeric | Essential | NSQIP |
| Preop | NSQIP predicted length of stay | Numeric | Essential | NSQIP |
| Preop | NSQIP predicted serious complications | Numeric | Essential | NSQIP |
| Preop | Haemoglobin (preoperative) | Numeric | Essential | — |
| Preop | Albumin (preoperative) | Numeric | Essential | — |
| Preop | Frailty score | — | Important | — |
| Preop | Dementia | Y / N | Important | — |
| Preop | Chronic pain | Y / N | Important | — |
| Preop | CRP (C-reactive protein) | Y / N | Important | — |
| Preop | Additional comorbidities | — | Discretionary | — |
| Intraop | Length of surgery | Numeric | Essential | — |
| Intraop | Vasopressor / inotrope use | Y / N | Important | — |
| Intraop | MER-level events | Count | Important | — |
| Intraop | Intraoperative crystalloid | — | Important | — |
| Intraop | Intraoperative colloid | — | Important | — |
| Intraop | Intraoperative blood products | — | Important | — |
| Intraop | Noradrenaline — average dose rate | — | Discretionary | — |
| Intraop | Adrenaline — average dose rate | — | Discretionary | — |
| Intraop | Phenylephrine — average dose rate | — | Discretionary | — |
| Intraop | Metaraminol — average dose rate | — | Discretionary | — |
| Intraop | Lactate | — | Discretionary | — |
| Postop | Haemoglobin (postoperative) | Numeric | Essential | — |
| Postop | Albumin (postoperative) | Numeric | Essential | — |
| Postop | GFR (postoperative) | Numeric | Essential | — |
| Postop | Length of stay at 30 days | Days | Essential | — |
| Postop | Readmission at 30 days | Number of readmissions | Essential | — |
| Postop | Readmission at 90 days | Number of readmissions | Essential | — |
| Postop | Mortality at 30 days | — | Essential | — |
| Postop | PACU MER-level events | Respiratory, cardiovascular, pain — count | Important | — |
| Postop | ARRC MER-level events (until morning after surgery) | Respiratory, cardiovascular, pain — count | Important | — |
| Postop | Treatment required for MER-level events | Fluid bolus, vasopressor, new oxygen, pain intervention | Important | — |
| Postop | CRP (postoperative) | Numeric | Important | — |
| Postop | ICU days | Days | Important | — |
| Postop | Days in hospital during readmission (30 days) | Days | Important | — |
| Postop | Days in hospital during readmission (90 days) | Days | Important | — |
| Postop | Mortality at 90 days | — | Important | — |
| Postop | Mortality at 365 days | — | Important | — |
| Postop | Days at Home at 30 days (DAH30) | Days | Important | — |
| Postop | Days at Home at 90 days (DAH90) | Days | Important | — |
How the registry is structured
300
Patients targeted across 5 centres for the pilot phase
3,000+
Existing patients from the Royal Adelaide Hospital ARRC program
The registry will be owned by the Network. Contributing centres will be able to:
Compare their outcomes with other contributing centres
Explore data to develop ideas and test hypotheses
Contribute to registry publications, on this website and in peer-reviewed journals
Join the pilot
Several centres are already contributing. Multicentre ethics approval for data collection in Australia is in place under the National Mutual Agreement. Funding is available to help centres get started.
Contact the Network to discuss how your centre can take part.