Quality assurance and economical efficiency in ambulatory surgery The German situation in gynaecological day surgery

In contrast to other countries, gynaecological ambulatory surgery in Germany today is mainly performed in private free-standing units. They perform approximately 98% of all ambulatory operations. A quality assurance programme in gynaecological ambulatory surgery started in the early 1980s and proved the safety of outpatient surgery in experienced hands. Gynaecological ambulatory surgery proved to be far more cost effective than inpatient operations. Independently specialised free-standing units seem to be able to work economically with a high level of quality. Due to the special legal situation in Germany the increasing number of outpatient operations led to a sharp drop in fees for individual operations. Quality assurance consists of many aspects. Most are well established and accepted. Apparently in ambulatory surgery the structural requirements of the operative unit, the organisation of postoperative care, the risk of thrombosis, the risk of infection and other aspects seem to be different to inpatient surgery. Comparative studies are required to investigate these differences. Only then it may be possible to optimise the integration of ambulatory surgery into the health system. © 1998 Published by Elsevier Science B.V. All rights reserved.