Читать книгу Ambulatory Urology and Urogynaecology - Группа авторов - Страница 23

The economic benefits of ambulatory surgery are a major drive for uptake. A number of studies have demonstrated the cost‐effectiveness of various procedures when performed in the outpatient versus inpatient setting (Hollingsworth 2012). In 1990, the UK's Audit Commission suggested that if all health authorities in England and Wales performed day surgery consistently for 20 common procedures, an additional 186 000 patients could be treated each year without increased costs. This led to the England's Department of Health recommendation that 75% of all elective surgery be undertaken as day‐case procedures (Alan Milburn NHS plan 2002). The UK Department of Health's reference costs for 2013–2014 calculated that the average day‐case cost was £698 compared to £3375 for elective inpatient cases (reference costs 2013–2014).

These economic benefits stem from shorter hospital stays, with reduced waiting lists and higher patient turnover; fixed scheduling with reduced cancellations; staff reductions with lower overnight capacity; reduced operating times and lower costs associated with post‐operative care (Aboutarabi 2014). Furthermore, patients benefit from reduced disruption from normal routine and quicker recovery back to work.

Various strategies have been proposed to economise even further within ambulatory surgery. Nerve blocks for reduction of pain, fast‐tracking, and modifying the type and amount of anaesthesia have all been investigated in detail. Future innovations in terms of surgical technology and technique, anaesthesia and post‐operative monitoring including the use of telemedicine will likely further the scope and economic efficiency of ambulatory surgery.