الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
The Ambulatory surgery. Human learned to operate on their follow being before they learned to te or record evidence of their operations. Through ages humans have been :aicated to helping others by surgery long before hospitals evolved as an lportant institution in our society. Thus A.S. is actually our oldest known ,Philosophy and concept: Concept indicates that surgical care for selected cases can be provided ectively and efficiently an on out patient basis. American hospital association division of Ambulatory care defined it as ~cheduled surgical procedures provided to patients who do not remain in the urgical care is classified in 3 levels: Levell. Minor Ambulatory surgery. Level 2. Major Ambulatory surgery. Level 3. Inpatient surgery. . Historical development : Look to the past, for on its pages is written the history of the future. ,S, is actually the oldest known surgery. Galen ”131 to 201/ A.D” described e ”Tabemae medicae ” where only ambulant sick were treated. There was many ebb and flow in the reported utilization and the practice ambulatory surgery since the middle of the previous centUry. But the odem concept of A.S was prKmeered in 1967 by Butter Worth Hospital of rand Rapids, Michigan, follo”,:,ed the next year by opening a similar unit at ’me University Hospital of California as a hospital based programme by Dr. David B. Cohen and John Dillons who were anaesthesiologists. Ambulatory Surgery: Does it add or replace inpatient surgery ? We see the ambulatory surgical centers and similar facilities as adjencts (0 the hospital system, not comptitors with it. 3. Advantages of ambulatory surgery: a) Reduced costs of surgical care which is due to procedures are perfonned on come and go basis without over night hospitalization, facility is desiged [om its inception to serve the needs’ of the ambulatory patients., better use is made of personnel. .. . .. ect. D) Less risk of nosocomial infections. c) Reduced bed congestion in busy hospital. cl) Patient life style minimalty changed. e) Less psychological stress of hospitalization. D Disability is decreased. g) Patient receives more individual attention. 4. Disadvantages: a) Patient may not adhere to pre-operative instruction. D) Patient may not have transportation. c) Patient may have no competant assistance at home. cl) Patient may be troubled by the absence of immediatly available supportive and resuscitative back up. e) Potentially reduced hospital income. D Possible increase in malpractice danger. 5. Types of units: I I b I. Under control of a hospital : a) Hospital integrated unit . b) Hospital autonomous unit . c) Hospital satellite unit. L’ Free standing unit. 6. The most important factors that may be considered” when we plan for ambulatory” surgical facility : I. Trends in community growth. 2. Tributary population. 3. Auticipated” changes in the medical staff. 4. Existing and proposed facilities in the community. 5. The inter hospital cooperation. 6. Forecasted fund raising projects by other hospitals in the community. Factors influencing the success of the program . 1. Quality of care. 2. Flexibility of program. 3. Participation of the physicians, and family members. 4. Competition in the area. 5. Patient satisfactions. Guidelines for organization of unit and for selection of patient and surgical procedures: I , I As is traditional in inpatient surgery, the surgeon selects the patient and schedules the operations that may be performed in out patient unit. Several factors influence his choice. First the patient must be prepared for and must agree to a short stay. We must be in good health; if he has a systemic disease it must be under good control. Second; the operative procedure to be performed must De of short duration, associated with minimal bleeding. The prime consideration in selecting a patient is the antipated recovery period. Basic laboratory data- blood tests and urinalysis are essential. In this study: I. Intensive review oflitratures developed a comprehensive lists of operations effectively & effeciently performed at different facilities in other conteries 2. Validation of the developed lists through interviewing health manpower. 3. Study of the practices of A. S in some Alexandria medical facilites was conducted by reviewing registers in out patient elin ics . 4. The physical, technical and manpower resources needed to accomplish this type of care have been studied through inter view of health man power. Potential A.S Ps at Gamal and Kannouz Hospital : The potiential constituted about 520/0 of all surgical procedures performed at Garnal & Karmouz hospitals during the first six months of 1992. The study revealed that P.A.S. Patients were mostly in age catergory 20 & less than 50 years. Most patients who are candidates for A.S are admitted on an elective basis. The proportion of emergency admissions were less than 10. Associated medical problems have a minimal impact on diminishing the nwnber of patients eligible for A. S. Spinal anaesthesia consitituted about half of all anaestheties administered. For 3,000 procedures 10,828 bed days could be saved if we use this modality of surgical care. cOWltey ? How much money can be saved all over the Post operative complications : The incidence of complications (all trivial). 92.55 of that potenial passed without post operative complications even without good selections, careful preanaeesthetic evaluations careful anaesthetic technique. So we can safely say that when it is under taken seriously and implemented with rigid control, we can expect less & less complications. . Health insurance hospitals must encourage elemination of unnecessary hospitalization. . Hospitals should participate in the program of A.S. . Governmintal hospitals should prepare themselves to participate in this modality of surgical care and choose the appropriate program. . Hospitals should encourage use of lasers and the sophisticated endoscopies to join the international trends towards A.S. . We should make. every effort to extend this concept to the nation as a whole. A study is needed to determine how many specific Egyptian pounds A.S. can save in the nations health care bill .^leng