For-profit day surgery sector showing fast growth in Europe

LONDON - The continuing growth and development of ambulatory (or day) surgery both in the United States and in Europe is impressive and has been fueled particularly by the availability of newer, short-acting anesthetics, technological advances in minimally invasive surgery and changes in health care financing.

Ambulatory surgery in the U.S.

Rebecca Twersky of the SUNY Health Science Center (Brooklyn, New York), speaking at the 2nd International Congress on Ambulatory Surgery here, estimated that the list of "acceptable" ambulatory procedures today totals in excess of 2,500 and continues to grow. She said, "Ambulatory surgery procedures that were once performed in the operating room are being relocated to less-intensive settings including hospital-based treatment or procedure rooms, free-standing ambulatory care centers and physicians' offices."

Twersky estimated that 35% of elective surgery still is carried out on an in-patient basis, but that that will diminish to 25% by 2010 (Table 1). Effectively, since total numbers of procedures continue to increase, this means that actual procedure totals on in-patients will remain virtually static, with the main growth sectors being the physician's office and freestanding surgery centers.

Table 1

Surgery Site Trends in U.S., 1982-2010

Surgery Site                        1982   1997   2010
projected

Physicians Office                     1%     8%    15%
Free standing surgery centers         1%    12%    17%
Hospital-based ambulatory surgery    18%    45%    43%
Hospital-based in-patient surgery    80%    35%    25%

Note: Total surgery procedures have increased from 20 million in
1980 to 30 million in 1995.

Source: International Congress on Ambulatory Surgery

The Graseby Model TCI anesthesia pump and the Fresenius Master TCI pump both use the Diprifusor subsystem to control the infusion rate according to preset parameters. A new arrival to this rapidly developing sector is the Harvard 2 dual-channel intra-venous anesthetic syringe pump produced by Harvard Clinical Technology (South Natick, Massachusetts). Harvard Clinical has signed an exclusive worldwide distribution agreement with the Ohmeda (Liberty Corner, New Jersey) health care division of BOC (Windlesham, England). Ohmeda already is a world market leader in anesthesia and respiratory products.

Safer endoscope processing

Safe disinfection of flexible and rigid endoscopes between procedures is a crucially important procedure, both for the patient and also for the nursing staff. Most disinfectants used are either glutaraldehyde-based, like Cidex from Johnson & Johnson Medical (Arlington, Texas), or peracetic acid-based, like NuCidex from Johnson & Johnson Medical or Steris 20 from Steris Corp. (Mentor, Ohio). These have largely replaced older formaldehyde disinfection procedures, but both new agents require closed or externally vented filter systems to ensure operator safety.

A number of endoscope disinfector units are available in Europe, from Astec Environmental Systems (Western-superMare, England), Labcaire Systems (Clevedon, England) and Safelab Systems (Bristol, England). They have been joined by the Steris System 1, recently launched on the British and German markets by new Steris sales companies in the two countries.

Although many hospitals still are using standard endoscopy fume hoods, there is an increasing interest in Europe in the use of automated flexiscope reprocessors such as the Inverness unit from Safelab or the Autoscope line from Labcaire. The Steris System 1 uses interchangeable JIT trays which are configured to the design of individual needs and designed to optimize exposure during sterilization and rinsing.

Table 2

Status of NHS Ambulatory Surgery in Britain, 1996

* 55% of elective surgery is ambulatory. This compares with 20% in 1988-1989.

* Ambulatory inguinal hernia repairs have increased from 4% in 1988/89 to More than 20% today.

* 51% of NHS hospitals (816) have self-contained day surgery units. More than 300 hospitals have no specific day surgery facilities.

* There currently are only 12 free-standing surgical centers.

* The Ministry of Health target is 70% of elective surgery on an ambulatory basis by 2010.

Source: International Congress on Ambulatory Surgery

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