D.1- Outpatient Surgery Centre

The Outpatient Surgery Centre is functionally and structurally designed to perform outpatient surgical procedures. Moderately complex surgical procedures are performed at the centre, where the patient, after a period of recovery and control, and independently from the technique used, is discharged to go home, thereby maintaining the same effectiveness and quality standards as those observed in a patient who has undergone surgery on a hospitalisation basis.

The Out-patient Surgery Centre has 2 anaesthesiologists on the morning shift (08.00 to 15.00 hours) and from 1 to 2 anaesthesiologists (depending on the surgery schedule) on the evening shift (15.00 to 22.00 hours). The duties of the anaesthesiologists working at this unit are:

• To perform a preoperative assessment if the patient has not been previously seen in the consulting offices and to collect the specific Informed Consent Form from the patient.
• To attend scheduled surgery and/or urgent surgery at the Out-Patient Surgery Unit
• To monitor the patient until discharge.
• To admit the patient to the hospital should a serious complication arise, whether it be a surgical or an anaesthetic complication.

Patient selection is initially carried out by the surgeon but the final green light is given the anaesthesiologist after evaluation of the preoperative assessment. The procedural scheme followed is shown below.

 

Patient inclusion or exclusion criteria are as follows:

A. Inclusion criteria relating to the procedure
1. No need for intravenous antibiotics in the postoperative period.
2. The procedure should not be carried out on a septic focus.
3. The surgical procedure should not require prophylactic heparinisation and should present small risk of blood loss.
4. Scarce probability to present severe complications during the postoperative course (mainly in terms of bleeding).
5. Approximate length of the procedure of 60 minutes under general anaesthesia. Should other anaesthetic techniques be used, this time is advisable but not imperative.

B. Inclusion criteria based on the patient's pathology
1. ASA I and II patients.
2. ASA III patients and exceptionally ASA IV patients, with compensated pathology and no decompensation episodes in the 3 months prior to the surgical procedure, and that will preferably undergo under regional or local anaesthesia with slight sedation.
3. Patients with COPD, type II diabetes (treated with ADO) in surgical procedures not requiring general anaesthesia, and insulin-dependent type I diabetes patients only in ophthalmologic procedures.
4. Obesity: Any associated pathology; the type of surgical procedure and the anaesthetic technique should be assessed individually in each case.

C. Exclusion criteria based on the patient´s pathology
1. Type I diabetes
2. COPD and type II diabetes (treated with ADO), in surgical procedures requiring general anaesthesia.
3. Psychiatric patients.
4. Drug dependence.
5. Treatment with anticoagulants and/or coagulation anomalies
6. Epilepsy.
7. Past history of serious anaesthetic complications in previous surgical procedures.
8. Risk of presenting malignant hyperthermia.
9. Paediatric patients under 18 months (with the exception of patients with an obstructed lacrimal sac, frenelum linguae, or delayed separation of the umbilical cord).
10. Patients with coronary pathology who presented clinical symptoms in the past two years, excepting cataract surgery (absence of symptoms 3 months prior to surgery).
11. Hypertension that is poorly controlled with medication.

The surgical disciplines with the highest incidence in the Out-Patient Surgery Unit are ophthalmology, paediatric surgery, traumatology and orthopaedic surgery, gynaecology, general surgery, ear and nose, and vascular surgery, respectively.

The most frequently anaesthetic techniques used are sedation, local anaesthesia, balanced general anaesthesia and peripheral blocks. In 2005, 1400 surgical procedures were carried out in the Out-Patient Surgery Unit with no significant complications to point out.