March 2015

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Number 1/15, March 2015

​News from the president


It is almost time for our 11th IAAS International Congress, which will be held in Barcelona in May. Our Spanish and Portuguese colleagues have arranged an exciting programme and I hope that I will be able to meet many of you there during this important meeting. This will be my last Newsletter as President and it seems just like yesterday that I took over in Budapest. I am pleased to report that the members of both the General Assembly and the Executive Committee have been busy over the last 2 years. We were fortunate to secure EU funding to support our training activities – this allowed us to develop and deliver the Train the Trainers programme. This has been a great success and the accompanying IAAS Day Surgery Handbook has been published online (see on our website) and it is available in multiple languages. If any country wishes to translate this handbook for local use then please let us know. The training programme has provided courses in Greece, Romania, Hungary, Croatia and Serbia – and I am pleased to report that each of these 2 day courses has been well received. We have just started work on some new small handbooks on Ambulatory Surgery looking at patient safety in day surgery and the day surgery pathway. Look out for these soon. Unfortunately we have not been able to secure EU funding for 2015 – however we plan to continue our training programme and we are working hard to secure commercial sponsors to achieve this. Finally I would like to thank everyone who has supported me during my tenure as President and I wish you all a successful 2015.

Ian Jackson, President

International News and Comments

The Portuguese Ambulatory Surgey Association (APCA) and the IAAS established a collaborative partnership that provided an observational fellowship for 2 medical doctors from Croatia. During the week 15th to 19th December 2014 Prof. Anko Antabak, Director of the Institute's University Hospital, Zagreb and Dr. Judith Deutsch (Anaesthetist) were able to stay at  CICA (Centro Integrado de Cirurgia Ambulatório) – Centro Hospitalar do Porto. Here they had direct contact and activity with one of the Portuguese national reference ambulatory surgery units.

APCA thanks all those who have enabled this event, including the IAAS, the CACH Porto and direction of CICA, the Anaesthetic Department and the Ambulatory Surgery Unit, as well as all professionals who made this a very productive week.
APCA hopes that other fellowships can be awarded in the future and that Portuguese professionals involved in Ambulatory Surgery may also have the same contact  with ASU's abroad.

Carlos Magalhães
APCA President

If you believe you could provide an attachment for a colleague who is interested in Ambulatory Surgery from another country could you please email the President with details. 

International articles

Appendectomy for non-complicated acute appendicitis can be performed in a true ambulatory setting with no overnignt stay.

Three kinds of medical advances, over the last ten years, have shown that non-complicated acute appendicitis fulfilled all the necessary conditions for performing appendectomy in an ambulatory setting: 1- Several epidemiological studies have shown that the pattern of progression of non-complicated appendicitis is totally different from that of complicated acute appendicitis [1], suggesting that two separate clinical forms of acute appendicitis exist–a complicated form with necrosis and risk of perforation from the onset, and a non-complicated form with no necrosis and no risk of perforation.  This further suggests that complicated appendicitis is not the outcome of untreated non-complicated appendicitis [1]; 2- all recent studies have shown that a delay of 6-12 hours before appendectomy does not increase the rate of appendicular perforation [2].  This confirms the hypothesis that the non-complicated form does not progress to perforation; 3- antibiotic treatment was instituted as first-line therapy with no increase in morbidity and mortality, and appendectomy was avoided in nearly 60 % of patients especially in case of non-complicated appendicitis [3]. 
However, until recently, despite their somewhat misleading titles, studies reporting purported “ambulatory” appendectomy for acute appendicitis have hospital stays exceeding 12 hours with overnight stay [4].
It is only in 2014 that a single French series [8], of true ambulatory appendectomy for non-complicated acute appendicitis was reported. Patients were selected preoperatively with a score. Score criteria were derived from data on 181 previous patients who had undergone appendectomy for acute appendicitis and who were successfully discharged on the first post-operative day; the five criteria were each assigned a value of one point: BMI < 28kg/m2, WBC count < 15,000/mm3, CRP < 3.0 mg/dL, absence of CT evidence of perforation, appendiceal luminal diameter < 10mm.  A favorable score was ≥ 4.   Patients arriving before 1 pm underwent surgery on the same day provided that an operative time slot was available.  Patients arriving after 1 pm received oral antibiotic therapy (Augmentin-3 gms) and were scheduled to return for surgery the following day, provided (once again) that an operating room was available. To date, 38 patients have undergone ambulatory management: 22 (58%) on the same day (median delay until surgery: 2.9 hours) and 16 (42%) the following morning (median delay until surgery: 15.5 hours).  All of the patients were discharged on the day of surgery except one patient (still overly sedated).  The total length of stay was 8.4 ±6.9 hours. There was no postoperative complication.
These data demonstrated that ambulatory appendectomy for non-complicated acute appendicitis is feasible with no increase in risks.

Corinne Vons, MD, PhD
French Association of Ambulatory Surgery (AFCA)


[1] Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg 2007; 245: 886–92.
[2] United Kingdom National Surgical Research Collaborative, Bhangu A. Collaborators (236). Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis. Ann Surg. 2014 ; 259: 894-903.
[3] Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet 2011; 377: 1573–9.
 [4] Ciardo LF, Agresta F, Bedin N. Day-case laparoscopic surgery for appendicitis and non-specific abdominal pain. Chir Ital 2007; 59: 299–304.
 [5] Lefrancois M, Lefevre JH, Chafai N, Pitel S, Kerger L, Agostini J, et al. Management of Acute Appendicitis in Ambulatory Surgery: Is It Possible? How to Select Patients? Ann Surg 2014. doi:10.1097/

News from Member Associations

Ambulatory Surgery Center Association - ASCA, Alexandria, VA, USA

You Are Invited to ASCA 2015
Registrations are being accepted for ASCA 2015, the annual meeting of the US Ambulatory Surgery Center Association (ASCA). The meeting will take place May 13–16, 2015, at the Orlando World Center Marriott Resort & Convention Center in Orlando, Florida. For a full conference schedule and registration information, go to
This meeting will feature more than 60 sessions covering all aspects of ASC management, including quality, cost control, patient care, future planning, staffing, new technology, supply contracting and business office management. Basic and advanced content will be provided.
National Benchmarking Program Supports Quality Improvement  
More than 900 ambulatory surgery centers (ASC) are now participating in ASCA Benchmarking—a fully online outpatient surgery benchmarking program that gives participants an opportunity to assess and compare their performance on 40 clinical and operational measures. Designed by benchmarking experts from around the country based on feedback from ASC professionals who have used other benchmarking tools in the past, ASCA’s new program incorporates a suite of user-friendly features, including:
Save-as-you-go data entry;
24/7 online access to data reports;
Streamlined, quick-to-complete survey design;
Pop-up help features;
Self-calculating worksheets;
Built-in data checks that help to ensure the accuracy of the information provided;
Easy-to-read, full-color reports that allow each ASC to quickly compare its results to national and specialty trends;          Sample reports from ASCA Benchmarking
Tips for getting started;
FAQ guide based on user feedback;
Phone and email support services; and Demographic data memory that allows users to update individual items as changes occur.For more information, go to

Arnaldo Valedon, ASCA


ASECMA INFORMATION: IAAS 11th World Congress - May 10-12, 2015

Dear Colleagues and Friends,
On behalf of the Local Organizing Committee we invite you to join us in Barcelona for the IAAS 11th World Congress, the 12th Congress of the Spanish Association and the 4th Iberian Congress on Ambulatory Surgery with the Portuguese Association (APCA).
We have created an attractive scientific programme, an update and review of procedures in ambulatory surgery. So, several workshops, courses, visits to Day Surgery Units and more sessions where attendees will be able to practice and learn in an interactive way have been organized. 
There will also be other types of sessions such as lectures, symposia, pro/con debates, panel discussions, special workshops, symposia and, of course, free paper and poster presentations,
Also included are specific sessions on Anaesthesia, Surgery and Nursing as well as multidisciplinary sessions. 

Registrations fees are different for the different categories of participants: members, residents, nursing staff and IAAS members.

Barcelona, with an excellent weather in the month of May and with a multicultural and modern lifestyle offers many options. Keep updated on the congress website
My colleagues and I look forward to welcoming you to Barcelona and to a very successful Congress.

Miquel Prats Maeso, Fernando Docobo Durántez, Luis Hidalgo Grau
Chairman, Local Organizing Committee 
Chairman, Scientific Committee
Secretary, Spanish National Association on Day Surgery

Ambulatory Surgery

Volume 21.1 - now available

Compliance with driving instructions following anaesthesia for a day-case procedure

M. Mitchell
Types of various surgeries in Day care: A study from South India
A. Lingaiah, P. Venugopal, K. R. Mridula & S. Bandaru
Apple and bananas when comparing recovery and patients satisfaction following day surgery
M. Brattwall, M .Warrén-Stomberg & J. Jakobsson
Prevalence of asymptomatic deep vein thrombosis in patients with inflammatory bowel diseases in the ambulatory surgery setting
G. Pellino, A. Reginelli, S. Canonico & F. Selvaggi

Carlo Castoro, Newsletter Editor-in-Chief

Paulo Lemos Portugal, Beverly Philip USA, Ian Jackson UK, Co-Editors

International Association for Ambulatory Surgery IAAS
President: Ian Jackson            
IAAS registered address: Tichelrei, 1 B-9000 GENT (Belgium) IAAS registered Number 0458.707.654
Email:                                                                     Internet:

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