Much more than just minor procedures in an extra-hospital environment, it is a multidisciplinary care strategy that focuses on the patient.
Outpatient surgeries are those performed in an outpatient basis. It is not to be confused with the concept of minor surgeries, commonly performed in offices, in physical structures that are sometimes rudimentary.
Despite the apparent simplicity, it is a much broader concept. It relates to a set of clinical protocols, surgical and anesthetic techniques, physical structures and specific environments, as well as modern management tools.
These are health strategies that aim to provide better clinical results and safety, with rationalization of costs.
After all, most surgical patients do not need expensive and complex hospital support structures, such as laundry, pharmacy or an ICU. But they cannot give up the safety and quality of cutting-edge anesthetic and surgical equipment and the comfort of assisted recovery, at home.
Modern outpatient surgery dates back to the early twentieth century, with the publication by James H. Nicoll of the successful results of nearly nine thousand operations on children at the Royal Hospital for Sick Children in Glasgow – Scotland. For his pioneering spirit, Nicoll is today considered worldwide the forefather of Ambulatory Surgery.
However, the concept currently employed internationally emerged in the USA in 1970. From the mid-1990s, it experienced a major expansion in European healthcare systems. More recently, it has been adopted with increasing success in Asian countries and even in some African countries.
International efforts to implement Ambulatory Surgery are strongly supported by IAAS – International Association for Ambulatory Surgery, based in Belgium and instituted in 1995.
The consolidation of the Ambulatory Surgery strategy follows the observation that the escalation of the complexity of the procedures has shaped the contemporary hospital structure to the growing technological and organizational demands of highly complex – and high-cost procedures – such as organ transplants, robotic surgeries and major oncological procedures.
Nevertheless, up to 80% of all procedures currently performed in hospital operation rooms, could be performed in an outpatient surgical unit, even outside a hospital, with advantages. Therefore, the concept of Ambulatory Surgery is strongly linked to that of dehospitalization.
Therefore, it is increasingly urgent to balance better clinical outcomes, lower risks, lower costs and greater safety, with the convenience and comfort of assisted recovery, at the patient’s home.
Ambulatory Surgery should be performed in properly equipped surgical environments and with multidisciplinary teams, dedicated specifically to outpatients. Also essential are well-defined protocols, with clinical and social criteria for patient admission, a specific circuit for health teams, patients and their caregivers.
Ambulatory Surgery strategies and programs can be carried out in hospitals or outside them, since hospital support structures such as ICUs, laundry, pharmacy, clinical engineering and lunchrooms can be outsourced or are just not needed to assist outpatients.
And it is important to emphasize that a good Ambulatory Surgery program must include not only medical-surgical procedures, but all those health procedures that require the typical physical structure of an operation room, but whose patients do not require an overnight stay. This is also the case for dental, endoscopic and even neurological procedures, such as electroconvulsive therapy, for example.
Therefore, it is a model that proposes to offer patients the physical and human structure typical of a hospital operation room, but only in the right measure of their needs. The aim is to avoid costly and unnecessary hospitalizations while ensuring comfort, convenience, accessibility and, above all, safety for patients.
Fighting for the implementation of the culture of Ambulatory Surgery in public and private areas and throughout the whole country is the mission of SOBRACAM.