Ambulatory anesthesia practices in Spain

Abstract

I N RECENT YEARS health care expenditure has soared in Europe, in part because an increasingly older population has created a higher demand for health services to treat chronic diseases. In addition, the rapid pace of social change, improved living standards, and longer life expectancy have led to a greater demand for surgical operations. All governments, whatever their political ideology, are seeking new ways of financing their health care services or evaluating cost containment programs because the constant increase in the resources allocated to health care has been insufficient to alleviate the problems generated by a greater and more costly demand. It is clear that the current economic situation requires greater levels of efficacy and efficiency. Optimal use of resources requires that new formulas be devised to meet the demand without compromising the quality of medical care, slowing down technological progress, or stopping research. Major ambulatory surgery (MAS) represents an alternative to traditional surgery requiring hospitalization. It arose as a response to rising health care costs and as a way to achieve greater efficacy in the use of hospital resources. Its development was made possible through new diagnostic and therapeutic techniques, minimally invasive surgery, and new anesthetic drugs. There is still confusion in Spain regm'cting the terminology to be used in this area and lack of agreement about the most appropriate definition for this medical subspecialty. The most widely known term is m a j o r a m b u l a tory surgery , which is used to distinguish this type of surgery from what is traditionally known as a mbu la to ry surgery (usually identified with minor surgery). Novel anesthetic drugs, minimally aggressive surgical techniques, and improved postoperative care have made it possible to perform surgical procedures traditionally requiring hospitalization on an ambulatory basis. On the other hand, the need to provide specific facilities for these procedures has Ied to the creation of specific surgical units known as Day Surgery Hospitals, in which ambulatory surgical procedures or day-case surgery is performed. The period of growth and consolidation of ambulatory surgery was in the 1980s, at which time the term major ambulatory surgery became established. The introduction of MAS has been slow in Spain. In recent years, through the initiative of individual practitioners, some isolated programs have been perforated, each one having its own peculiarities in terms of program design, hospital stay, and postdischarge follow-up. The first MAS programs were not started in Spain until the end of the eighties and beginning of the nineties. The first Major Ambulatory Surgery Unit was created in 1988 as part of the Toledo Hospital Center. The Major Ambulatory Surgery Unit of the Hospital of Viladecans (Barcelona) was established in 1990. A private Major Ambulatory Surgery Unit was created in Madrid in 1992. 1992 was an emblematic year for MAS in Spain. The first Congress on MAS was held in Barcelona in February 1992. Later in the same year, the Spanish Society of Major Ambulatory Surgery and Short Inpatient Stay was founded. It is from this time on when the development of MAS began to be promoted in Spain.