Objective: The objective of this study was to establish the number, quality and main findings of randomised controlled studies on the effectiveness and cost-effectiveness of high dependency units (HDUs) in early post-operative case management. Design: Systematic review: a comprehensive search of all major and supplementary electronic databases, supplemented by hand searches of principal journals and experts in the field. Main results: No systematic reviews of randomised controlled (or controlled) trials in an HDU environment, or in any other critical care area were found. No single instances of randomised controlled (or controlled) trials in an HDU, or other critical care areas were found. Conclusions: No hard evidence, in the form of randomised studies, has been established regarding the effectiveness and cost-effectiveness of HDUs.