1. 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.

2. 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.

3. INTRODUCTION
• Studies worldwide have shown that day care
surgery delivers the same high quality care and is
as safe as given to hospital patients.

4. • 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.

5. 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.

6. REQUIREMENTS ( CONTD…)
• Clear Pre and post – operative instructions.
• Post – operative medications should be in oral
form.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. THANK YOU
DR. H. G. DOCTOR