AMBULATORY SURGERY

Requirements – Benefits

DR. H. G. DOCTOR

M.S., F.R.C.S., F.I.C.S., F.A.C.R.S.I., F.I.A.G.E.S.

Vice President, Medical Services

NOVA Medical Centres, Mumbai

Member of Ambulatory Surgery Centers, USA.

President, Hernia Society Of India.

Prof. Emeritus of Surgery

Grant Medical College & Sir J.J. Group of Hospitals, Mumbai.

HISTORICAL BACKGROUND

• The concept of Ambulatory Surgery was started in 1909 by

James Nicholl. He was a surgeon at western infirmary,

Glasgow, Scotland.

• In 1912, Ralph Waters, Anaesthetist, Iowa, USA, opened “

Down-town anaesthesia clinic”.

• In 1969, Walter Redd, surgeon, started “Phoenix

Surgicenter” where hernia cases were also operated with

same day discharge.

• Benefits of ambulatory surgery were more and better

realized after World War II.

• Eric Farquharson described in 1955 consecutive 458

inguinal hernia repairs performed as day care cases.

INTRODUCTION

• Studies worldwide have shown that day care

surgery delivers the same high quality care and is

as safe as given to hospital patients.

• It is a planned procedure on selected group of

patients who are admitted and discharged on the

same day of their surgery but who require

appropriate facilities, care and time for recovery.

• Due to newer modalities of laser, ultracission and

endoscopes being available, minimal access

surgery, and all endoscopic procedures also can

be performed.

REQUIREMENTS

• State – of – the art operation theatres are

mandatory along with comfortable and hygienic

environment.

• Selection of an ideal patient and ideal standard

surgical procedure.

• Preadmission surgical, medical and anaesthetic

assessment. Ambulatory surgery centre should

have ideal diagnostic and surgical equipment and a

sophisticated laboratory.

• Should be supervised by committed & dedicated

surgeons, physicians, anaesthetists & nurses to

ensure highest standards of patient care.

REQUIREMENTS ( CONTD…)

• Clear Pre and post – operative instructions.

• Post – operative medications should be in oral

form.

REQUIREMENTS ( CONTD…)

• Patients with stable vital signs for at least 1 hour;

orientation to time, place, and persons only

should be sent home.

• Availability of a responsible person to transport

the patient home and stay with him overnight.

• Proper guidelines should be provided,

implemented and audited regularly.

• Facilities should be available for overnight stay if

necessary and should have a liason with nearest

major hospital in unforeseen complications of

surgery and anaesthesia.

BENEFITS

• Ambulatory surgery provides high quality, patient –

centered treatment that is safe, efficient and

effective and is accompanied by a lower incidence

of hospital acquired infection.

BENEFITS (CONTD….)

• Early return to work reduces the manhour loss, as

compared with in patient treatment.

• Patients are more comfortable and relaxed in their

own environment.

• Waiting lists of indoor patients are reduced.

• Cost reduction and better utilization of resources

and it is economical.

• Reduced incidence of DVT as prolonged bed rest

is not needed.

BENEFITS (CONTD….)

• Additionally, ambulatory surgery enables busy

professionals to return home and recover faster,

enhancing their productivity by eliminating

avoidable hospitalization.

• Insurance companies also support the use of

ambulatory care facilities, primarily because of

decreased cost.

CONCLUSION

• Ambulatory Surgery is now a global trend.

• Over 70% of elective surgeries in the USA and

65% in UK are performed this way.

• Ambulatory Surgery is getting well established in

India also.

THANK YOU

DR. H. G. DOCTOR