title: Ambulatory surgery in orthopedics: experience of over 10,000 patients.
abstract: OBJECTIVE
  The concept of day surgery is becoming an increasingly important part of elective surgery worldwide. Relentless pressure to cut costs may constrain clinical judgment regarding the most appropriate location for a patient's surgical care. The aim of this study was to determine clinical and quality indicators relating to our experience in orthopedic day durgery, mainly in relation to unplanned overnight admission and readmission rates. Additionally, we focused on describing the main characteristics of the patients that experienced complications, and compared the patient satisfaction rates following ambulatory and non-ambulatory procedures.
  
  
  METHODS
  We evaluated 10,032 patients who underwent surgical orthopedic procedures according to the protocols of our Ambulatory Surgery Unit. All complications that occurred were noted. A quality-of-life assessment (SF-36 test) was carried out both pre- and postoperatively. Ambulatory substitution rates and quality indicators for orthopedic procedures were also determined.
  
  
  RESULTS
  The major complication rate was minimal, with no mortal cases, and there was a high rate of ambulatory substitution for the procedures studied. Outcomes of the SF-36 questionnaire showed significant improvement postoperatively. An unplanned overnight admission rate of 0.14 % was achieved.
  
  
  CONCLUSIONS
  Our institution has shown that it is possible to provide good-quality ambulatory orthopedic surgery. There still appears to be the potential to increase the proportion of these procedures. Surgeons and anesthesiologists must strongly adhere to strict patient selection criteria for ambulatory orthopedic surgery in order to reduce complications in the immediate postoperative term.
authors.affiliation: Service of Traumatology and Orthopaedic Surgery, Clinic Universitary Hospital of Valladolid, Valladolid, Spain.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Martín-Ferrero
authors.affiliation: Service of Traumatology and Orthopaedic Surgery, Hospital of Ávila-Sacyl, Ávila, Spain; C\Antonio Montesinos, N° 2, 1° C, 37003 Salamanca, Spain. Electronic address: ofmartin@msn.com.
authors.forename: O
authors.initials: O
authors.lastname: Faour-Martín
authors.affiliation: Service of Traumatology and Orthopaedic Surgery, Clinic Universitary Hospital of Valladolid, Valladolid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Simon-Perez
authors.affiliation: Service of Anaesthesiology, Clinic Universitary Hospital of Valladolid, Valladolid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pérez-Herrero
authors.affiliation: University of Salamanca, Salamanca, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: de Pedro-Moro
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D009985:Orthopedics; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult