To the editor: We greatly appreciate the paper by O Helseth et al1 entitled “Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe: A Consecutive Single Center Series of 1449 Patients” because the authors led us to consider that innovative surgery is achievable in day surgery, concluding “in favor of outpatient spinal surgery in properly selected patients.”1 They also remind us that nonmedical criteria could represent a major challenge for developing early discharge. Indeed, “patients who had a travel distance >1.5 h by car were advised to stay overnight at a hotel adjacent to the clinic.” Thus, “1446 out of 1449 (99.8%) patients were successfully discharged either to their homes or to a hotel on the day of surgery.”1 Like the authors, in France, surgeons are faced with “limited healthcare resources and steadily increasing rates of surgery,” and they have “to be a focus on efficient and cost-effective treatment.”1 Today, ambulatory surgery has become a priority for the government, making it a national challenge. The recent implementation of an incentive pricing system by the National Health Insurance and the constant increase of the type of procedures referenced for ambulatory surgery2 increased the rate from 32.2% in 2007 to 37.7% in 2010, aiming to reach 50% in 2016.3 However, these measures still encounter some difficulties. The first of these is that, in France, the hospital stay in an ambulatory surgery unit is limited by law to no more than 12 h from the patient's admission to his discharge. In their study, the authors have fixed the limit at 6 h of postoperative observation. This could be a problem, as all the scheduled patients could not be first on the theatre list. In our multidisciplinary ambulatory surgery unit, the earlier the patients are operated, the more likely they are to return home the same day. Another difficulty concerns the patients without social home support or for whom home is far away from the hospital, regardless of their medical eligibility for day surgery. In this study, it would be very interesting to have more details on the distribution between a return home and an accommodation in a hospital hotel. The fact remains that medical literature on hospital hotel is not profuse. In France, the lack of hospital hotels is critical, too often leading to hospital conventional accommodation for patients who do not medically require it, either for the preoperative night and/or for the night following the day of surgery, leading to additional costs.4,5 A nation-wide experiment has just been voted on by the Parliament, and the experimentation should take place very soon. The problem of funding of this project has to be solved, either by the national health system of care, or by the private insurance companies. This also means modifying habits of our patients. Disclosures Pr Jean-Pierre Bethoux is the head of the Day Surgery Observatory of the Regional Health Agency of Paris and its area. Pr Henri-Jean Philippe is the head of the College of the Ambulatory Surgery of the AP–HP (Assistance Publique-Hôpitaux de Paris). The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.