[Ambulatory chest surgery].

as any therapeutic or diagnostic surgical procedure performed under general, regional, or local anesthesia, with or without sedation, which requires short-stay postoperative care rather than admission to hospital. According to the International Association for Ambulatory Surgery, the procedure should not be urgent, should be performed within a single normal working day, and should not require more than 12 hours, including the postoperative recovery period. Of the alternatives to conventional hospitalization that have been proposed in recent decades, the practice of ambulatory surgery (also referred to as same-day surgery or outpatient surgery) is becoming more widespread in Spain and internationally. That said, until relatively recently, ambulatory chest surgery was performed very infrequenty in Spain, 1 and there have been few references to ambulatory mediastinoscopy in the international medical literature since the first important study was published by Vallières et al 2 in 1991. The fact that ambulatory chest surgery is not included in major outpatient surgery programs has been attributed by Pun 3 to a numbers of factors. Medical reasons include anatomical complexity, prolonged postoperative recovery, potentially serious complications, and the frequent need for negative-pressure thoracic drainage—not to mention the postoperative pain that is typically associated with chest surgery. Nonmedical reasons undoubtedly include the shorter waiting lists for chest surgery compared to other specialties, a reluctance to assume the greater medical and legal responsibilities implied, and low demand from patients, who generally receive little information in regard to outpatient surgery. Although the Spanish ambulatory surgery association (Asociación Española de Cirugía Mayor Ambulatoria) recorded a total of 139 outpatient surgery units in Spain in 2006, only 3 of these units have published descriptions of their experiences. Ambulatory chest surgery, like any other outpatient surgery, requires the establishment of validated management and quality indicators, such as the substitution rate (defined as the number of patients undergoing outpatient surgery expressed as a percentage of the total number of patients undergoing the same procedure), the unplanned admission rate, and the readmission rate, all of which have been used in a number of studies. The subject of the first publication on major ambulatory chest surgery was mediastinoscopy for staging bronchogenic carcinoma, 2 which continues to be the most widely practiced procedure in ambulatory chest surgery units. In our recent study of ambulatory chest surgery performed on 300 patients, 5 we reported a substitution rate of 86% and an admission rate of 0.95% (2 patients) for 210 …