Author: Tran L et al.
A & A Practice 19(8):e02008, August 2025. doi:10.1213/XAA.0000000000002008
This systematic review evaluated the impact of enhanced postoperative care units (EPCUs) for adult patients undergoing noncardiac, non-neurological surgery. EPCUs provide intermediate-level care between general surgical wards and ICUs, offering higher nurse-to-patient ratios, specialized staff, and access to critical interventions such as vasopressor therapy.
From 9774 screened records, 12 studies (13 reports) were included. Evidence was mixed: two studies showed significantly reduced 30-day mortality, one reported increased days at home by 30 days, and three demonstrated shorter hospital stays with EPCU care. However, heterogeneity in study designs, small sample sizes, and overall very low certainty of evidence limited conclusions. While EPCUs may improve outcomes, especially in anesthesia-led models, current research remains insufficient to firmly establish their effectiveness or safety. Expansion should be cautious and coupled with robust evaluation.
What You Should Know
• EPCUs provide an intermediate care level between surgical wards and ICUs.
• 12 studies reviewed; overall evidence remains low-certainty.
• Some studies showed reduced 30-day mortality, more days at home, and shorter hospital stays.
• Findings were inconsistent due to heterogeneity and small sample sizes.
• EPCUs may be beneficial, but further high-quality research is needed before widespread implementation.
References
World Health Organization
Injuries and Violence Factsheet, 2024. https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence
American Society of Anesthesiologists
Statement on Principles: Trauma Anesthesiology. https://www.asahq.org/standards-and-practice-parameters/statement-on-principles-trauma-anesthesiology
Thank you to A & A Practice for making this work available.