Ambulatory surgery is one of the few win-win medical activities, meaning it is advantageous to both
patient and organisation in all the different aspects
of its management: safety, quality, efficiency and
sustainability.
Uncountable scientific works have already demonstrated at least equal safety for numerous surgical procedures performed in the setting of
ambulatory surgery (AS). This refers to expected
and non-expected, immediate and late medical
complications. In fact, the number of ambulatory surgical procedures accounts for
more than 75% of all non-urgent surgeries performed in developed countries like
those of Northern Europe and the United States. This results, of course, in high savings for health care systems but also on the availability of more surgical hospital
beds and faster recovery of surgical waiting lists.
General surgery, urology, gynaecology, orthopaedic, ophthalmic, dental and
ENT surgical specialities have all developed minimally invasive techniques that
cause less tissue trauma and pain that allow better and faster control of all the variables that are involved on a safe discharge from the AS units. More and more procedures are included each year in the “basket” of AS in face of this evolution.
Anaesthesia protocols for AS must always target to quick recovery of preoperative status at a minimum imbalance of the hemodynamic, respiratory and neurologic
functions of the patient. Selected drugs must be of rapid metabolisation/elimination
and be easily titrated or antagonized. Pain and PONV are the main concerns that
guide the clinical conduct of the anaesthesiologist. The cornerstone of a successful
AS programme is patient selection and patient/caregiver education. Focus must
always be on the patient himself and not the surgical procedure that he is being
submitted. It is of fundamental importance that a thorough preoperative evaluation
includes not only the clinical but also the social aspects of patient’s normal daily
life. Postoperative recovery and rehabilitation strategies should be, as early as possible discussed, understood and consented by patient and caregiver.
Expected level of pain or postoperative nausea and vomiting (PONV), for example, should be in the mind of every member of the multidisciplinary surgical team,
as soon as surgical and anaesthetic technique is decided. Severe pain and PONV are among the most common causes of late discharge, unexpected patient admission
and readmission after discharge home and should be always avoided as they can
trigger other unwanted complications as chronic pain and thrombosis.
Every AS unit must have well-defined discharge criteria and some kind of postoperative quality control checkout. Phone calls at 24–48 h can be a useful tool, as it
may identify early signs of morbidity. Anonymous enquiries will also have an
important role in defining what different actions may be undertaken to improve the
organization’s efficiency and patient satisfaction.
This book will bring you not only the highlights of many of these topics but a
deeper insight to details that make a big difference when you want excellence in
your clinical practice. This will be noticed not only on fewer complications but also
on increased patient and staff satisfaction.
Congratulations to Professor Begani for this important initiative!