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Procedures in Ambulatory Surgery

Procedures can be performed as a day case provided there is satisfactory control of symptoms postoperatively and patients regain the ability to drink and eat within a reasonable time after the completion of surgery. Pain, nausea and vomiting must be controlled and preferably the patient should be able to mobilise to some extent. Enthusiasts are pushing the boundaries of what is possible around the world – radical prostatectomy, laparoscopic nephrectomy and even hip replacement have been managed as day cases. New operative techniques such as endoscopic surgery and other types of minimal access surgery have been developed and surgeons have become increasingly aware of important issues such as patient selection and proper perioperative care in ambulatory surgery. The fundamental principle however should be that surgery undertaken as a day case must be based on proven patient safety and quality of care, units should therefore be careful when introducing new procedures.
Ambulatory surgery was originally limited to procedures lasting less than 60 minutes. However with appropriate patient selection, the use of modern anaesthetic agents and careful postoperative care longer surgical procedures are now regularly performed. Many units have no specified maximum duration of operation. Some hospitals have developed 23-hour stay facilities to support the introduction of more major procedures and tackle postoperative complications without re-admission to another hospital. These may assist the transfer of an operation from the inpatient to the ambulatory surgery arena and extend the use of total capacity of ambulatory surgery operating theatres into the early evening.