The potential impact of ambulatory surgery in Catalonia, Spain

BACKGROUND: In recent years, ambulatory surgery has received much attention in Catalonia, Spain, because of its potential to reduce unnecessary bed utilization. To estimate the number of potentially ambulatory procedures could be useful for planning and contracting health care services and could give an idea of its potential impact in the existing health care system. METHODS: The number of hospital discharges in Catalonia (1993) for 34 groups of procedures suitable for ambulatory surgery were obtained from the computerised uniform hospital discharge system. The percentage of procedures that could be carried out as day cases published in three delphi studies were applied to the number of hospital discharges to estimate a target number of ambulatory procedures. The number of hospital bed days that could be saved was calculated multiplying the estimated number of ambulatory procedures by the actual average length to stay for each procedure. Finally, Delphi substitution percentages were compared to those reported by a Catalan hospital with an ambulatory surgery unit. RESULTS: The estimated annual number of ambulatory procedures ranges from 37,453 to 44,752 (6.5 to 7.7% of the annual hospital discharges) and the estimated hospital day from 159, 773 to 193,709 (3.3 to 4.0% of all hospital bed days). Among the procedures with the highest potential in ambulatory surgery there are: cataract surgery, inguinal hernia repair, uterine dilatation and curettage, and arthroscope. Most of the reported hospital substitution indexes are positioned between the highest and the lowest delphi indexes. CONCLUSIONS: A significant percentage of the procedures currently carried out on an inatient basis could be performed in ambulatory arrangements. The hospital reported percentages of substitution suggest the feasibility of achieving the estimated number of ambulatory procedures. In the Catalan public health sector, ambulatory surgery has shown an increasing trend towards the estimated number of ambulatory procedures.