[Integration, organization and results of ambulatory surgery in a central hospital]

Principally driven by economic necessity, i.e. reduction of health care personnel and beds, a significant increase in number of major operations for in-patients and a general attempt to reduce costs, a day-surgery unit was established for the Surgical Department at the Kantonsspital St. Gallen. Several requirements have to be met: Standardized techniques have to be applied by experienced surgeons and strict selection criteria for patients as well as intensive preoperative patient information and consenting have to be observed. During a two year period (September 1992 to August 1994) 389 patients were evaluated for ambulatory surgery. 106 patients (27.2%) had to be rejected for social, medical and financial reasons. Eventually operations were carried out on 283 patients. The majority of procedures performed were for herniae (37.8%) followed by varicose vein-surgery (22.6%). Only 8 patients had to be admitted for observation as in-patients, this was mainly due to difficulties in postoperative mobilisation and micturition problems. To monitor our quality of care, questionnaires were sent to patients and general practitioners (GP's). 98% of patients were satisfied with the preoperative information standards. Difficulties in adapting to a postoperative daily routine was stated by 13% of patients. 80% of patients would again opt for surgery on a day-care basis in future. 81% of GP's reported a positive benefit for their patients from ambulatory surgery. All GP's were prepared to undertake preoperative patient evaluation according to standardized selection criteria. A significant reduction in costs can be expected. With the current health-insurance system this is unfortunately achieved with an increased financial burdening for the patient.