THE POTENTIAL IMPACT OF AMBULATORY SURGER Y IN CATALONIA, SPAIN

BACKGROUND: In recent years, ambulatory surgery has received much atte ntion in Catalonia, Spain, because of its potential to reduce unnecess ary bed utilization. To estimate the number of potentially ambulatory procedures could be useful for planning and contracting health care se rvices and could give an idea of its potential impact in the existing health care system. METHODS: The number of hospital discharges in Cata lonia (1993) for 34 groups of procedures suitable for ambulatory surge ry were obtained from the computerised uniform hospital discharge syst em. The percentage of procedures that could be carried out as day case s published in three delphi studies were applied to the number of hosp ital discharges to estimate a target number of ambulatory procedures. The number of hospital bed days that could be saved was calculated mul tiplying the estimated number of ambulatory procedures by the actual a verage length to stay for each procedure. Finally, Delphi substitution percentages were compared to those reported by a Catalan hospital wit h 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 proce dures with the highest potential in ambulatory surgery there are: cata ract 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. CONC LUSIONS: 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 feasib ility of achieving the estimated number of ambulatory procedures. In t he Catalan public health sector, ambulatory surgery has shown an incre asing trend towards the estimated number of ambulatory procedures.