[National survey of preoperative management and patient selection in ambulatory surgery centers].
BACKGROUND
The objective of this study was to determine both the selection and preparation criteria in patients in various Spanish ambulatory surgery centers, as well as the impact of these criteria on their results. The results were compared according to the type of functional structure of the units (autonomous or integrated).


METHODS
We performed a cross sectional, descriptive study through postal survey. The survey contained the following items: type of unit, surgical procedures, selection criteria, preoperative assessment and management, and qualitative and quantitative indexes of the activity performed in 2000. A total of 123 units were included with a response rate of 39%.


RESULTS
The selection criteria showed a high degree of consensus. The outpatient anesthesia clinic was used for preoperative assessment by 97.9% of the units. Most units routinely requested preoperative tests (hemostasis and hemogram by 89%; biochemical parameters by 72.9%) and to a lesser extent chest X-ray (33.3%) and electrocardiogram (35.4%). The introduction of procedures for the management of coexisting diseases was scarce (25-64.6%). Units using the outpatient anesthesia clinic in all patients had a lower cancellation rate (1.5% vs 4.4%). Autonomous units were significantly more likely to accept patients with high surgical-anesthetic risk than integrated units. Autonomous units also showed a significantly lower number of admissions (1.2% vs 1.9%, p = 0.003), mean stay (240 min vs 367 min, p = 0.002), and recovery time (150 min vs 212 min, p = 0.001) than integrated units. No statistically significant differences were found in the remaining parameters.


CONCLUSIONS
Scientifically based protocols for patient selection, preoperative assessment and perioperative management of distinct processes and for the rational use of laboratory tests should be more widely used. The need for an outpatient anesthesia clinic for preoperative assessment was notable. The results of our survey indicate that better results in performance indexes are achieved in autonomous ambulatory surgery units than in integrated units. Given the possibility of defining and validating quality standards, further multicenter studies should be performed.
Servicio de Anestesiología y Reanimación. Hospital Universitari de Tarragona Joan XXIII. Tarragona. Spain. jpapa@comt.es
J
J
Papaceit
M
M
Olona
C
C
Ramón
R
R
García-Aguado
R
R
Rodríguez
M
M
Rull
D000556:Ambulatory Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data*; D000761:Anesthesia Department, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D002391:Catchment Area, Health; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods / Q000592:standards*; D013030:Spain; D013531:Surgicenters / Q000458:organization & administration* / Q000592:standards