A surgeon's view: how ARRC changed our approach to high-risk recovery
We spoke with Associate Professor Tarik Sammour about his experience working with the Advanced Recovery Room Care (ARRC) unit at the Royal Adelaide Hospital.
Early skepticism
What were your initial thoughts of ARRC prior to its inception?
"It seemed very similar to an HDU or ICU environment, and I wasn't sure where the value would come from. But Professor Ludbrook was clearly passionate about it, and the academic component appealed to me. We thought it couldn't hurt to try it and see what came of it."
A shift in opinion
How has your opinion of ARRC changed since its implementation?
“Pretty much after the first exenteration patient went there, we noticed immediate benefits, and these have persisted since.
More specifically, the singular focus on day 0/1 elective, moderate-risk, postop patients was uniquely catered to, and requires a different protocol and skill set than general ICU/HDU, which has a mix of emergency/elective patients at multiple time points after admission.
Also, the shared care and decision-making between surgery and anaesthetics was quite refreshing, and I believe leads to better care than the loss of surgical input we tend to see in ICU.”
What changed for patients
What have you noticed in your patients that has driven this change?
"The most immediate change was in recovery speed for pelvic exenteration patients. Since ARRC began, 7 of 8 patients were discharged safely to the general ward within 24 hours — compared with a median ICU stay of 3 days beforehand.
Almost none of these patients needed to return to ICU at any stage of recovery. That's not just a saving in ICU bed days and fewer day-of-surgery cancellations — it's a sign of what specialised shared care can achieve."
Impact on practice
How has ARRC impacted your practice and your surgical unit?
"We manage the same complexity of patients as before. But we're far more confident that the first few days of recovery will be smooth and uneventful, with early rescue and accelerated recovery built in."
ARRC’s value
Asked to sum up ARRC's value in a sentence, A/Prof Sammour offered this:
"Specialised short-term postoperative care for moderate-to-high-risk elective surgery patients, in a shared-care ARRC setting, significantly reduces reliance on ICU and accelerates patient recovery."
Associate Professor Tarik Sammour
Tarik is an Associate Professor of Colorectal Surgery and Colorectal Surgical Oncologist with specific interest in complex pelvic malignancy and robotic surgery.