Major ambulatory surgery: Where we are and where are we going.

In the late 1950s, centers dedicated to major ambulatory surgery (MAS) were first established in Vancouver and later in Washington and California. The first totally independent center (‘‘Surgicenter’’) was inaugurated in February 1970 in Phoenix (Arizona), conceived by 2 anesthesiologists, Wallace Reed and John Ford, for ambulatory interventions without the participation of traditional hospitals. That day, they performed 5 ambulatory interventions, 4 of them with general anesthesia. In 2011, more than 5300 centers in the US carried out more than 23 million interventions without hospitalization. In October 1990, 20 years later, a multidisciplinary, autonomous and integrated non-hospitalization unit was opened at the Hospital de Viladecans in Spain. The International Association for Ambulatory Surgery (IAAS) was founded in 1995, coinciding with its first international congress (third European) in Brussels. The founding members had begun the publication of the Ambulatory Surgery journal in 1993, which is currently available at www.iaas-med. com. In addition, the IAAS organizes a biennially medical congress. In addition to the IAAS was the then-newly created Spanish Association of Major Ambulatory Surgery (Asociación Española de Cirugı́a Mayor Ambulatoria, ASEMAS), which was preparing its second national congress in Seville. The first had been in Barcelona in 1992, organized by the Hospital de Viladecans. ASEMAS, which has been holding congresses and meetings between congresses every year, created its own journal. The congress of 2017 was the 13th national congress that, simultaneously, was the 6th Iberian congress, which is an international congress organized in collaboration with the Portuguese Association of Ambulatory Surgery (Associação Portuguesa de Cirurgia Ambulatoria) and is the result of an interesting symbiosis between both associations. In Spain, according to data from the Ministry of Health, Social Services and Equality, the percentage of outpatient surgery of the total of number of operations went from 10.4% in 1997 to 16.3% in 2000, which is an increase of 5.9%. In 2001, the development of MAS units by Spanish autonomous communities was very unequal, although this has now been surpassed, with only minor differences among the regions. In Catalonia, there was an increase in ambulatory surgery activity and a decrease in surgery with hospitalization in the period from 2001 to 2011. In 2014, the Ministry recognized 763 hospitals (345 public and 418 private), with 4352 operating rooms, 434 of which are dedicated to MAS. Between 2010 and 2014, 2 148 895 surgeries with hospital admission and 1 281 903 outpatient surgeries were performed, which represents an outpatient rate of 37.36%. Not all of these interventions correspond to General Surgery, but to all services that perform interventions under this modality. If we analyze the data of our specialty, the rate of ambulatory surgery has varied from 27.86% in 2010 to 30.14% in 2014. We have the infrastructures and the support of professional organizations, but the increase in ambulatory activity in 4 yrs has only been just over 2%, which must make us take pause. First, we must consider how we account for MAS. The classic idea of the patient admitted early in the morning and released the same day has given way to other modalities. Many of these patients are involved in afternoon surgery programs, which are the current competition for established MAS programs, as they consume the same resources as MAS units with the added costs of the overnight stay. It is necessary to unify criteria when we speak of MAS and, therefore, to unify the language. Under the heading of MAS, different autonomous communities include procedures as diverse as minor surgery, MAS, prolonged-recovery surgery (23-h surgery, overnight surgery) or short-stay surgery. It is necessary for c i r e s p . 2 0 1 8 ; x x ( x x ) : x x x – x x x